- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $8,128.31 / $16,218.10
| Facility | | $3,388.44 | $8,128.31 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,071.52 / $2,754.23
| Professional | | $616.60 | $1,071.52 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,047.13 / $1,995.26
| Professional | | $524.81 | $1,047.13 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $10,000.00 / $22,387.21
| Facility | | $6,309.57 | $10,000.00 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $977.24 / $1,412.54
| Professional | | $562.34 | $977.24 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,230.27 / $2,041.74
| Professional | | $602.56 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,089.30 / $12,022.64
| Facility | | $691.83 | $2,089.30 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | 52 | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | 53 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | AS | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,318.26 / $5,011.87
| Professional | | $758.58 | $1,318.26 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,479.11 / $2,041.74
| Professional | | $1,230.27 | $1,479.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,230.27 / $2,041.74
| Professional | | $1,096.48 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $1,174.90 / $1,659.59
| Professional | | $7.08 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $7,762.47 / $10,000.00
| Facility | | $6,918.31 | $7,762.47 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $1,621.81
| Professional | | $724.44 | $1,023.29 | $1,621.81 |