- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $524.81 / $3,388.44
| Facility | | $89.13 | $524.81 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $295.12 / $1,096.48
| Professional | | $63.10 | $295.12 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $70.79 / $194.98 / $354.81
| Professional | 52 | $70.79 | $194.98 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $229.09 / $724.44
| Professional | | $81.28 | $229.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Professional | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $588.84 / $954.99
| Facility | | $512.86 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $229.09 / $676.08
| Professional | | $87.10 | $229.09 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $467.74 / $3,801.89
| Facility | | $77.62 | $467.74 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $562.34
| Professional | | $134.90 | $208.93 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $501.19 / $1,778.28
| Facility | | $77.62 | $501.19 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $1,174.90
| Professional | | $199.53 | $371.54 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $229.09
| Professional | | $32.36 | $33.11 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $891.25 / $2,344.23
| Facility | | $128.82 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $660.69
| Professional | | $173.78 | $281.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $251.19 / $660.69
| Professional | | $107.15 | $251.19 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $4,365.16 / $4,365.16
| Facility | | $398.11 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $478.63
| Facility | 52 | $323.59 | $323.59 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $588.84 / $1,348.96
| Professional | | $95.50 | $588.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $467.74
| Professional | | $154.88 | $154.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $380.19 / $1,148.15
| Professional | | $169.82 | $380.19 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,584.89 / $2,187.76
| Facility | | $977.24 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $229.09 / $707.95
| Professional | | $79.43 | $229.09 | $707.95 |