- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $3,019.95 / $8,912.51
| Facility | | $281.84 | $3,019.95 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $218.78 / $489.78
| Professional | | $77.62 | $218.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $363.08
| Professional | 52 | $45.71 | $85.11 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $21.38 / $34.67 / $134.90
| Professional | 53 | $21.38 | $34.67 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $218.78 / $416.87
| Professional | | $72.44 | $218.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,089.30 / $6,456.54
| Facility | | $758.58 | $2,089.30 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $213.80 / $346.74
| Professional | | $120.23 | $213.80 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $109.65 / $154.88
| Facility | | $97.72 | $109.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $281.84 / $467.74
| Professional | | $263.03 | $281.84 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $213.80 / $457.09
| Professional | | $109.65 | $213.80 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $218.78 / $416.87
| Professional | | $72.44 | $218.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $524.81
| Professional | 22 | $190.55 | $190.55 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $154.88
| Professional | 52 | $56.23 | $56.23 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $154.88
| Professional | 53 | $56.23 | $56.23 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,677.35 / $4,677.35
| Facility | | $2,137.96 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $389.05 / $457.09
| Professional | | $309.03 | $389.05 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,995.26 / $3,090.30
| Facility | | $426.58 | $1,995.26 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $208.93 / $407.38
| Professional | | $93.33 | $208.93 | $407.38 |