- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $2,570.40 / $7,762.47
| Facility | | $269.15 | $2,570.40 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | 52 | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $478.63 / $3,981.07
| Professional | | $194.98 | $478.63 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $537.03
| Professional | | $194.98 | $245.47 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $16,595.87
| Facility | | $302.00 | $302.00 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $3,235.94 / $53,703.18
| Facility | | $34.67 | $3,235.94 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | 22 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 52 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | AS | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $309.03 / $776.25
| Professional | | $158.49 | $309.03 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $229.09 / $707.95
| Facility | | $190.55 | $229.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $309.03 / $478.63
| Professional | | $229.09 | $309.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $229.09 / $389.05
| Professional | | $154.88 | $229.09 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $50,118.72 / $75,857.76
| Facility | | $194.98 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $295.12 / $645.65
| Professional | | $239.88 | $295.12 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,511.89 / $4,897.79
| Facility | | $1,318.26 | $2,511.89 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $257.04 / $616.60
| Professional | | $134.90 | $257.04 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $229.09 / $549.54
| Facility | | $173.78 | $229.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $251.19 / $630.96
| Professional | | $154.88 | $251.19 | $630.96 |