- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,905.46 / $4,365.16
| Facility | | $269.15 | $1,905.46 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $173.78 / $457.09
| Professional | | $77.62 | $173.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $363.08
| Professional | 52 | $45.71 | $85.11 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $134.90
| Professional | 53 | $34.67 | $34.67 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $102.33 / $138.04
| Facility | | $83.18 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $467.74 / $478.63
| Professional | | $91.20 | $467.74 | $478.63 |
- 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
- $89.13 / $234.42 / $1,258.93
| Professional | | $89.13 | $234.42 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,630.27 / $4,265.80
| Facility | | $707.95 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $1,949.84
| Facility | | $691.83 | $691.83 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $169.82 / $331.13
| Professional | | $77.62 | $169.82 | $331.13 |