- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $2,951.21 / $12,589.25
| Facility | | $478.63 | $2,951.21 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $154.88 / $562.34
| Professional | | $87.10 | $154.88 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $128.82 / $239.88
| Professional | | $102.33 | $128.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,466.84 / $12,022.64
| Facility | | $2,570.40 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $338.84
| Professional | | $85.11 | $125.89 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $1,023.29 / $2,041.74
| Facility | | $85.11 | $1,023.29 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $288.40
| Professional | | $93.33 | $131.83 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | 52 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $138.04 / $251.19
| Professional | | $95.50 | $138.04 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $123.03 / $190.55
| Professional | | $46.77 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $257.04
| Professional | | $95.50 | $147.91 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $1,659.59
| Facility | | $54.95 | $56.23 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | 52 | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,096.48 / $1,096.48
| Professional | | $933.25 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $181.97
| Professional | | $109.65 | $109.65 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $199.53
| Facility | | $79.43 | $123.03 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $141.25 / $275.42
| Professional | | $95.50 | $141.25 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $426.58
| Professional | | $309.03 | $309.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $79.43 / $144.54
| Professional | | $48.98 | $79.43 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,548.82 / $6,456.54
| Facility | | $575.44 | $1,548.82 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $114.82 / $245.47
| Professional | | $79.43 | $114.82 | $245.47 |