- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $933.25 / $3,715.35
| Facility | | $112.20 | $933.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $239.88 / $758.58
| Professional | | $79.43 | $239.88 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Professional | 52 | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $26.30 / $134.90 / $134.90
| Professional | 53 | $26.30 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $218.78 / $275.42
| Professional | | $74.13 | $218.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | 52 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,570.40 / $15,848.93
| Facility | | $1,412.54 | $2,570.40 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $199.53 / $389.05
| Professional | | $97.72 | $199.53 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $138.04
| Facility | | $72.44 | $104.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $204.17 / $281.84
| Professional | | $89.13 | $204.17 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $1,318.26
| Facility | | $134.90 | $134.90 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | 22 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Facility | 52 | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Facility | 53 | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $239.88 / $1,258.93
| Professional | | $117.49 | $239.88 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,445.44 / $2,630.27
| Facility | | $389.05 | $1,445.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $190.55 / $346.74
| Professional | | $85.11 | $190.55 | $346.74 |