- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $691.83 / $5,495.41
| Facility | | $190.55 | $691.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $363.08 / $630.96
| Professional | | $141.25 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $151.36
| Professional | | $131.83 | $131.83 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,235.94 / $15,848.93
| Facility | | $1,584.89 | $3,235.94 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $323.59 / $467.74
| Professional | | $131.83 | $323.59 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $208.93
| Facility | | $125.89 | $177.83 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $213.80
| Professional | | $117.49 | $181.97 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $239.88 / $1,659.59
| Facility | | $181.97 | $239.88 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 22 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $489.78 / $1,949.84
| Professional | | $165.96 | $489.78 | $1,949.84 |
- 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
- $602.56 / $3,467.37 / $6,025.60
| Facility | | $602.56 | $3,467.37 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $331.13 / $707.95
| Professional | | $138.04 | $331.13 | $707.95 |