- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $3,311.31 / $13,803.84
| Facility | | $512.86 | $3,311.31 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $616.60 / $1,445.44
| Professional | | $257.04 | $616.60 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $467.74
| Professional | | $407.38 | $407.38 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,162.28 / $6,456.54
| Facility | | $2,238.72 | $3,162.28 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $870.96 / $1,513.56
| Professional | | $407.38 | $870.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $741.31 / $1,819.70
| Facility | | $436.52 | $741.31 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Facility | 22 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | 52 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | 53 | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $691.83 / $1,737.80
| Professional | | $302.00 | $691.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $851.14 / $1,698.24
| Facility | | $371.54 | $851.14 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $724.44 / $1,584.89
| Professional | | $323.59 | $724.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $162.18
| Professional | | $32.36 | $33.11 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,258.93 / $1,380.38
| Facility | | $851.14 | $1,258.93 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $912.01 / $933.25
| Facility | | $741.31 | $912.01 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $912.01 / $1,659.59
| Professional | | $346.74 | $912.01 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,235.94 / $6,456.54
| Facility | | $2,187.76 | $3,235.94 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $891.25 / $1,513.56
| Professional | | $407.38 | $891.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $3,715.35 / $6,918.31
| Facility | | $812.83 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $707.95 / $1,412.54
| Professional | | $316.23 | $707.95 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $467.74 / $1,071.52
| Professional | | $245.47 | $467.74 | $1,071.52 |