- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,818.38 / $4,365.16
| Facility | | $741.31 | $2,818.38 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $446.68 / $1,000.00
| Professional | | $245.47 | $446.68 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $104.71 / $114.82 / $186.21
| Professional | 53 | $104.71 | $114.82 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $4,466.84 / $4,570.88
| Facility | | $1,258.93 | $4,466.84 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $870.96 / $1,621.81
| Professional | | $457.09 | $870.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,659.59 / $4,073.80
| Facility | | $1,174.90 | $1,659.59 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $933.25 / $1,862.09
| Professional | | $478.63 | $933.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | 53 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,479.11 / $3,162.28
| Facility | | $1,230.27 | $1,479.11 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $870.96 / $1,698.24
| Professional | | $537.03 | $870.96 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,348.96 / $3,090.30
| Facility | | $416.87 | $1,348.96 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $2,818.38
| Facility | 22 | $602.56 | $602.56 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $933.25 / $1,995.26
| Professional | | $524.81 | $933.25 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,412.54 / $1,995.26 / $2,089.30
| Professional | 53 | $1,412.54 | $1,995.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,019.95 / $4,897.79
| Facility | | $1,584.89 | $3,019.95 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $630.96 / $1,380.38
| Professional | | $295.12 | $630.96 | $1,380.38 |