- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,621.81 / $6,918.31
| Facility | | $371.54 | $1,621.81 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $602.56 / $1,122.02
| Professional | | $257.04 | $602.56 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $331.13 / $537.03
| Professional | | $245.47 | $331.13 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $295.12 / $2,951.21
| Professional | | $245.47 | $295.12 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $645.65 / $831.76
| Facility | | $436.52 | $645.65 | $831.76 |
- 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
- $288.40 / $549.54 / $1,071.52
| Professional | | $288.40 | $549.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $891.25 / $1,445.44
| Professional | | $676.08 | $891.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $870.96 / $1,047.13
| Professional | | $758.58 | $870.96 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $645.65 / $1,202.26
| Facility | | $295.12 | $645.65 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $1,380.38
| Professional | | $524.81 | $524.81 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $389.05 / $1,122.02
| Facility | | $263.03 | $389.05 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $812.83 / $2,137.96
| Professional | | $630.96 | $812.83 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,511.89 / $5,370.32
| Facility | | $575.44 | $2,511.89 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $537.03 / $1,122.02
| Professional | | $251.19 | $537.03 | $1,122.02 |