- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $4,365.16 / $6,918.31
| Facility | | $588.84 | $4,365.16 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $1,659.59
| Professional | | $245.47 | $457.09 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $812.83
| Professional | 53 | $109.65 | $169.82 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $478.63 / $1,445.44
| Professional | | $302.00 | $478.63 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $489.78
| Facility | | $234.42 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $501.19 / $977.24
| Professional | | $398.11 | $501.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,412.54 / $2,238.72
| Facility | | $1,202.26 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | 22 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | 52 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | 53 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $776.25 / $1,905.46
| Professional | | $331.13 | $776.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $512.86 / $3,311.31
| Facility | | $263.03 | $512.86 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $794.33 / $1,230.27
| Professional | | $457.09 | $794.33 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,479.11 / $3,801.89
| Facility | | $302.00 | $1,479.11 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $912.01
| Facility | 52 | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 53 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,288.25 / $3,467.37
| Professional | | $478.63 | $1,288.25 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,737.80
| Professional | 53 | $1,318.26 | $1,318.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $407.38
| Professional | | $32.36 | $33.11 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $3,890.45 / $4,570.88
| Facility | | $616.60 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $912.01 / $1,584.89
| Professional | | $489.78 | $912.01 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $794.33 / $1,659.59
| Professional | | $398.11 | $794.33 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $3,630.78 / $3,630.78
| Facility | | $426.58 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | 22 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $338.84 / $1,949.84 / $2,884.03
| Facility | 52 | $338.84 | $1,949.84 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $489.78 / $724.44
| Facility | 53 | $85.11 | $489.78 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,047.13 / $3,548.13
| Professional | | $316.23 | $1,047.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $1,737.80
| Professional | | $912.01 | $912.01 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,479.11 / $2,344.23
| Professional | | $912.01 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,311.31 / $6,606.93
| Facility | | $2,754.23 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $660.69 / $1,905.46
| Professional | | $95.50 | $660.69 | $1,905.46 |