- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $4,677.35 / $9,772.37
| Facility | | $338.84 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $426.58 / $2,089.30
| Professional | | $141.25 | $426.58 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $1,412.54
| Professional | | $123.03 | $257.04 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,011.87 / $10,232.93
| Facility | | $3,630.78 | $5,011.87 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $489.78 / $2,454.71
| Professional | | $239.88 | $489.78 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $758.58 / $2,454.71
| Facility | | $257.04 | $758.58 | $2,454.71 |
- 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
- $186.21 / $457.09 / $2,884.03
| Professional | | $186.21 | $457.09 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $912.01 / $2,818.38
| Facility | | $194.98 | $912.01 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $436.52 / $2,398.83
| Professional | | $177.83 | $436.52 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $95.50
| Professional | | $32.36 | $33.11 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,995.26 / $2,089.30
| Facility | | $288.40 | $1,995.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,479.11 / $1,548.82
| Facility | | $977.24 | $1,479.11 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $1,479.11 / $2,691.53
| Professional | | $208.93 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $5,248.07 / $10,232.93
| Facility | | $3,467.37 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $575.44 / $2,398.83
| Professional | | $239.88 | $575.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $5,495.41 / $10,715.19
| Facility | | $870.96 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $380.19 / $2,187.76
| Professional | | $186.21 | $380.19 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $281.84 / $1,737.80
| Professional | | $147.91 | $281.84 | $1,737.80 |