- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $4,897.79 / $8,511.38
| Facility | | $870.96 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $870.96 / $2,754.23
| Professional | | $309.03 | $870.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $954.99 / $2,754.23
| Professional | | $741.31 | $954.99 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,230.27 / $3,311.31
| Professional | | $302.00 | $1,230.27 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $2,754.23 / $8,912.51
| Facility | | $812.83 | $2,754.23 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | 53 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,995.26 / $4,265.80
| Professional | | $776.25 | $1,995.26 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,187.76 / $2,754.23
| Professional | | $794.33 | $2,187.76 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,344.23 / $3,162.28
| Professional | | $691.83 | $2,344.23 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $8,709.64 / $12,589.25
| Facility | | $3,019.95 | $8,709.64 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $758.58 / $1,949.84
| Professional | | $323.59 | $758.58 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $7,079.46 / $10,232.93
| Facility | | $4,168.69 | $7,079.46 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,047.13 / $3,019.95
| Professional | | $380.19 | $1,047.13 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $776.25 / $2,187.76
| Professional | | $660.69 | $776.25 | $2,187.76 |