- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $2,570.40 / $8,317.64
| Facility | | $316.23 | $2,570.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $426.58 / $2,570.40
| Professional | | $218.78 | $426.58 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $1,071.52 / $1,071.52
| Professional | 53 | $83.18 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $275.42 / $1,621.81
| Professional | | $177.83 | $275.42 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $5,128.61 / $12,302.69
| Facility | | $2,344.23 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $436.52 / $912.01
| Professional | | $251.19 | $436.52 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $302.00 / $407.38
| Facility | | $208.93 | $302.00 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,148.15 / $1,548.82
| Professional | | $269.15 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $1,862.09
| Facility | | $316.23 | $398.11 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | 22 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Facility | 52 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | 53 | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $588.84 / $5,754.40
| Professional | | $295.12 | $588.84 | $5,754.40 |
- 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
- $794.33 / $3,467.37 / $6,456.54
| Facility | | $794.33 | $3,467.37 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $2,089.30
| Professional | | $223.87 | $407.38 | $2,089.30 |