- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $4,365.16 / $8,511.38
| Facility | | $416.87 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $512.86 / $1,778.28
| Professional | | $199.53 | $512.86 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $257.04
| Professional | | $218.78 | $218.78 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,128.61 / $10,000.00
| Facility | | $3,890.45 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $724.44 / $1,659.59
| Professional | | $229.09 | $724.44 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $831.76 / $2,630.27
| Professional | | $436.52 | $831.76 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,445.44 / $6,456.54
| Facility | | $239.88 | $1,445.44 | $6,456.54 |
- 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
- $1,122.02 / $1,737.80 / $3,311.31
| Professional | | $1,122.02 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,905.46 / $2,398.83
| Professional | | $436.52 | $1,905.46 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $1,949.84
| Professional | | $446.68 | $446.68 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $331.13 / $2,570.40
| Professional | | $6.03 | $331.13 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,630.78 / $6,760.83
| Facility | | $2,570.40 | $3,630.78 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,047.13 / $2,137.96
| Professional | | $281.84 | $1,047.13 | $2,137.96 |