- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $912.01 / $9,772.37
| Facility | | $67.61 | $912.01 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $323.59
| Facility | 52 | $162.18 | $162.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $204.17 / $676.08
| Professional | | $36.31 | $204.17 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $676.08 / $1,348.96
| Facility | | $537.03 | $676.08 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $251.19 / $501.19
| Professional | | $58.88 | $251.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $501.19 / $954.99
| Facility | | $64.57 | $501.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 52 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $213.80 / $575.44
| Professional | | $44.67 | $213.80 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $239.88 / $588.84
| Facility | | $46.77 | $239.88 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $194.98 / $512.86
| Professional | | $44.67 | $194.98 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $56.23
| Professional | | $23.44 | $32.36 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $426.58 / $457.09
| Facility | | $257.04 | $426.58 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $309.03 / $316.23
| Facility | | $173.78 | $309.03 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $309.03 / $562.34
| Professional | | $51.29 | $309.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $691.83 / $1,348.96
| Facility | | $512.86 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $251.19 / $501.19
| Professional | | $58.88 | $251.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $776.25 / $1,737.80
| Facility | | $213.80 | $776.25 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $204.17 / $457.09
| Professional | | $45.71 | $204.17 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $67.61 / $398.11
| Professional | | $35.48 | $67.61 | $398.11 |