- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $2,041.74 / $7,943.28
| Facility | | $251.19 | $2,041.74 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | 52 | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $281.84 / $691.83
| Professional | | $112.20 | $281.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $158.49 / $269.15
| Professional | | $97.72 | $158.49 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,890.45 / $7,943.28
| Facility | | $3,090.30 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $398.11 / $602.56
| Professional | | $165.96 | $398.11 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $371.54 / $776.25
| Professional | | $169.82 | $371.54 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $398.11 / $2,089.30
| Facility | | $141.25 | $398.11 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 52 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Facility | 53 | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $426.58 / $2,137.96
| Professional | | $213.80 | $426.58 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $776.25
| Professional | | $263.03 | $537.03 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $446.68 / $676.08
| Professional | | $234.42 | $446.68 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,737.80 / $1,737.80
| Facility | | $1,479.11 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $416.87 / $812.83
| Professional | | $5.01 | $416.87 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,630.27 / $6,760.83
| Facility | | $1,122.02 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $316.23 / $660.69
| Professional | | $158.49 | $316.23 | $660.69 |