- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $1,659.59 / $2,570.40
| Facility | | $0.87 | $1,659.59 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $758.58 / $1,778.28
| Professional | | $194.98 | $758.58 | $1,778.28 |
- 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
- $281.84 / $1,047.13 / $3,548.13
| Professional | | $281.84 | $1,047.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,570.40 / $4,168.69
| Facility | | $2,238.72 | $2,570.40 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | 52 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Facility | 53 | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $831.76 / $3,162.28
| Professional | | $269.15 | $831.76 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $831.76 / $3,467.37
| Facility | | $199.53 | $831.76 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $831.76 / $2,238.72
| Professional | | $363.08 | $831.76 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $891.25 / $4,786.30
| Facility | | $199.53 | $891.25 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | 52 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | 53 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,995.26 / $6,025.60
| Professional | | $1,000.00 | $1,995.26 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $302.00
| Professional | | $32.36 | $33.11 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $3,890.45 / $4,570.88
| Facility | | $446.68 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,288.25 / $3,311.31
| Professional | | $512.86 | $1,288.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $933.25 / $2,630.27
| Professional | | $323.59 | $933.25 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $3,311.31 / $4,897.79
| Facility | | $346.74 | $3,311.31 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $275.42 / $2,630.27 / $3,890.45
| Facility | 52 | $275.42 | $2,630.27 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $660.69 / $977.24
| Facility | 53 | $69.18 | $660.69 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,479.11 / $6,165.95
| Professional | | $251.19 | $1,479.11 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $3,235.94
| Professional | | $741.31 | $741.31 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,884.03 / $4,265.80
| Professional | | $758.58 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,548.13 / $6,760.83
| Facility | | $2,754.23 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $891.25 / $2,884.03
| Professional | | $223.87 | $891.25 | $2,884.03 |