- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $2,570.40 / $7,244.36
| Facility | | $660.69 | $2,570.40 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $371.54 / $1,905.46
| Professional | | $144.54 | $371.54 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $1,023.29
| Professional | | $104.71 | $165.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,995.26 / $11,220.18
| Facility | | $831.76 | $1,995.26 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $1,202.26
| Professional | | $144.54 | $204.17 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $870.96 / $2,951.21
| Facility | | $257.04 | $870.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Facility | 22 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Facility | 52 | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $1,737.80
| Professional | | $154.88 | $309.03 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $6,165.95 / $11,481.54
| Facility | | $3,467.37 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $208.93 / $1,318.26
| Professional | | $89.13 | $208.93 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $117.49 / $380.19
| Professional | | $32.36 | $117.49 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $3,090.30 / $6,760.83
| Facility | | $794.33 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $245.47 / $1,513.56
| Professional | | $128.82 | $245.47 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $218.78 / $1,202.26
| Professional | | $117.49 | $218.78 | $1,202.26 |