- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $1,819.70 / $5,248.07
| Facility | | $81.28 | $1,819.70 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $125.89 / $398.11
| Professional | | $53.70 | $125.89 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $67.61 / $338.84
| Professional | | $30.90 | $67.61 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $154.88
| Facility | | $117.49 | $138.04 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $199.53 / $446.68
| Professional | | $81.28 | $199.53 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $251.19 / $478.63
| Facility | | $151.36 | $251.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | 52 | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Facility | 53 | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $154.88 / $354.81
| Professional | | $67.61 | $154.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Professional | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $144.54 / $288.40
| Facility | | $56.23 | $144.54 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $446.68
| Professional | | $100.00 | $100.00 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,691.53
| Facility | | $2,398.83 | $2,398.83 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $288.40
| Professional | | $79.43 | $123.03 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,412.54 / $3,467.37
| Facility | | $251.19 | $1,412.54 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $123.03 / $239.88
| Professional | | $53.70 | $123.03 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $13,489.63
| Facility | | $2,951.21 | $2,951.21 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | 52 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 53 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,584.89
| Professional | | $1,318.26 | $1,318.26 | $1,584.89 |