- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $5,370.32 / $9,772.37
| Facility | | $870.96 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $575.44 / $2,691.53
| Professional | | $218.78 | $575.44 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $776.25
| Professional | 53 | $109.65 | $177.83 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $309.03 / $2,137.96
| Professional | | $208.93 | $309.03 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $3,019.95 / $6,456.54
| Facility | | $1,148.15 | $3,019.95 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $549.54 / $2,290.87
| Professional | | $309.03 | $549.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $316.23 / $457.09
| Facility | | $281.84 | $316.23 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,548.82 / $2,570.40
| Professional | | $1,445.44 | $1,548.82 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $7,244.36 / $9,772.37
| Facility | | $4,168.69 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $537.03 / $2,884.03
| Professional | | $275.42 | $537.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $660.69 / $1,949.84
| Professional | | $208.93 | $660.69 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $3,630.78
| Professional | 22 | $691.83 | $691.83 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $1,071.52
| Professional | 52 | $199.53 | $199.53 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $1,071.52
| Professional | 53 | $199.53 | $199.53 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $8,912.51 / $17,378.01
| Facility | | $3,235.94 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $851.14 / $2,691.53
| Professional | | $616.60 | $851.14 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $3,890.45 / $6,606.93
| Facility | | $1,202.26 | $3,890.45 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $2,398.83
| Professional | | $251.19 | $446.68 | $2,398.83 |