- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $4,073.80 / $12,589.25
| Facility | | $660.69 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $467.74 / $1,348.96
| Professional | | $251.19 | $467.74 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $104.71 / $144.54 / $269.15
| Professional | 53 | $104.71 | $144.54 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $257.04 / $562.34
| Professional | | $199.53 | $257.04 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | 53 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,466.84 / $12,022.64
| Facility | | $2,570.40 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $588.84 / $1,000.00
| Professional | | $363.08 | $588.84 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $4,073.80 / $8,912.51
| Facility | | $85.11 | $4,073.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $602.56 / $1,148.15
| Professional | | $338.84 | $602.56 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $891.25 / $1,621.81
| Facility | | $537.03 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $501.19 / $891.25
| Professional | | $295.12 | $501.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Professional | 53 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $398.11 / $831.76
| Professional | | $251.19 | $398.11 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $478.63 / $933.25
| Professional | | $223.87 | $478.63 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $28,840.32
| Facility | | $3,715.35 | $3,715.35 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | 52 | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Facility | 53 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $3,548.13 / $3,801.89
| Professional | | $407.38 | $3,548.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $630.96
| Professional | | $32.36 | $33.11 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $512.86 / $891.25
| Facility | | $269.15 | $512.86 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $512.86 / $977.24
| Professional | | $288.40 | $512.86 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $1,479.11
| Professional | | $831.76 | $831.76 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $562.34 / $758.58
| Professional | | $229.09 | $562.34 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $3,981.07 / $9,120.11
| Facility | | $1,905.46 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $426.58 / $870.96
| Professional | | $234.42 | $426.58 | $870.96 |