- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,511.89 / $7,762.47
| Facility | | $524.81 | $2,511.89 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $2,344.23 / $6,165.95 / $10,715.19
| Facility | 22 | $2,344.23 | $6,165.95 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | 53 | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $467.74 / $933.25
| Professional | | $316.23 | $467.74 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $380.19
| Professional | | $338.84 | $338.84 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,981.07 / $5,623.41
| Facility | | $2,041.74 | $3,981.07 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $398.11 / $575.44
| Professional | | $371.54 | $398.11 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,511.89 / $2,754.23
| Facility | | $398.11 | $2,511.89 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $446.68 / $776.25
| Professional | | $275.42 | $446.68 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $870.96 / $2,951.21
| Professional | | $346.74 | $870.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $416.87 / $446.68
| Professional | | $389.05 | $416.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $398.11
| Professional | | $32.36 | $33.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,344.23 / $5,011.87
| Facility | | $1,174.90 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $489.78 / $891.25
| Professional | | $295.12 | $489.78 | $891.25 |