- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $2,951.21 / $7,943.28
| Facility | | $107.15 | $2,951.21 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | 52 | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $151.36 / $602.56
| Professional | | $53.70 | $151.36 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $89.13 / $112.20
| Professional | | $43.65 | $89.13 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,454.71 / $4,897.79
| Facility | | $1,737.80 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $186.21 / $398.11
| Professional | | $87.10 | $186.21 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $467.74 / $630.96
| Facility | | $95.50 | $467.74 | $630.96 |
- 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 / $177.83 / $467.74
| Professional | | $67.61 | $177.83 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $190.55 / $812.83
| Facility | | $77.62 | $190.55 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $165.96 / $416.87
| Professional | | $69.18 | $165.96 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $60.26
| Professional | | $32.36 | $33.11 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $316.23 / $363.08
| Facility | | $120.23 | $316.23 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $257.04 / $257.04
| Facility | | $229.09 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $257.04 / $467.74
| Professional | | $77.62 | $257.04 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,511.89 / $4,897.79
| Facility | | $1,698.24 | $2,511.89 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $213.80 / $398.11
| Professional | | $87.10 | $213.80 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,691.53 / $5,248.07
| Facility | | $549.54 | $2,691.53 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $158.49 / $354.81
| Professional | | $69.18 | $158.49 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $112.20 / $316.23
| Professional | | $58.88 | $112.20 | $316.23 |