- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $2,238.72 / $7,079.46
| Facility | | $501.19 | $2,238.72 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $234.42 / $812.83
| Professional | | $66.07 | $234.42 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $169.82 / $371.54
| Professional | | $70.79 | $169.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $512.86 / $977.24
| Professional | | $213.80 | $512.86 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $588.84 / $912.01
| Facility | | $489.78 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | 22 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | 52 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Facility | 53 | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $371.54 / $724.44
| Professional | | $173.78 | $371.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $363.08 / $630.96
| Facility | | $141.25 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $954.99
| Professional | | $309.03 | $309.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $354.81 / $588.84
| Professional | | $194.98 | $354.81 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,398.83 / $6,165.95
| Facility | | $398.11 | $2,398.83 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $302.00 / $549.54
| Professional | | $134.90 | $302.00 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $28,840.32
| Facility | | $2,884.03 | $2,884.03 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | 52 | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | 53 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $3,090.30
| Professional | | $2,630.27 | $2,630.27 | $3,090.30 |