- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,238.72 / $5,495.41
| Facility | | $776.25 | $2,238.72 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $478.63 / $1,202.26
| Professional | | $245.47 | $478.63 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $812.83
| Professional | 53 | $104.71 | $158.49 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,698.24 / $2,884.03
| Facility | | $1,122.02 | $1,698.24 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $616.60 / $891.25
| Professional | | $426.58 | $616.60 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $812.83
| Professional | | $309.03 | $489.78 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $676.08 / $1,698.24
| Facility | | $338.84 | $676.08 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $562.34 / $1,000.00
| Professional | | $288.40 | $562.34 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $812.83
| Professional | 53 | $104.71 | $151.36 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,398.83 / $3,715.35
| Facility | | $1,698.24 | $2,398.83 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $630.96 / $912.01
| Professional | | $426.58 | $630.96 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $501.19 / $1,412.54
| Professional | | $398.11 | $501.19 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $6,165.95 / $7,762.47
| Facility | | $3,467.37 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $501.19 / $851.14
| Professional | | $288.40 | $501.19 | $851.14 |