- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $2,951.21 / $7,762.47
| Facility | | $323.59 | $2,951.21 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $660.69
| Professional | | $208.93 | $275.42 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $588.84
| Professional | | $199.53 | $245.47 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,258.93 / $4,073.80
| Facility | | $346.74 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $346.74
| Professional | | $331.13 | $331.13 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,318.26 / $50,118.72
| Facility | | $407.38 | $1,318.26 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 54 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $363.08 / $977.24
| Professional | | $239.88 | $363.08 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $288.40 / $676.08
| Facility | | $128.82 | $288.40 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $616.60
| Professional | | $288.40 | $436.52 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | 54 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $323.59 / $512.86
| Professional | | $190.55 | $323.59 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $323.59 / $630.96
| Professional | | $275.42 | $323.59 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $50,118.72 / $75,857.76
| Facility | | $229.09 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $707.95
| Professional | | $275.42 | $398.11 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,398.83 / $4,897.79
| Facility | | $954.99 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $954.99
| Professional | | $208.93 | $316.23 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $954.99
| Facility | | $204.17 | $302.00 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $158.49 / $162.18 / $239.88
| Facility | 54 | $158.49 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $302.00 / $645.65
| Professional | | $199.53 | $302.00 | $645.65 |