- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $2,630.27 / $8,317.64
| Facility | | $407.38 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $389.05 / $1,122.02
| Professional | | $295.12 | $389.05 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $323.59 / $389.05
| Professional | | $275.42 | $323.59 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,801.89 / $8,511.38
| Facility | | $2,290.87 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $338.84 / $467.74
| Professional | | $288.40 | $338.84 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $446.68
| Facility | | $269.15 | $380.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $457.09
| Professional | | $281.84 | $389.05 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $1,862.09
| Facility | | $512.86 | $512.86 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 22 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | 52 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | 53 | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $512.86 / $1,862.09
| Professional | | $309.03 | $512.86 | $1,862.09 |
- 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 / $6,456.54
| Facility | | $602.56 | $3,467.37 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $416.87 / $588.84
| Professional | | $263.03 | $416.87 | $588.84 |