- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $4,677.35 / $10,000.00
| Facility | | $446.68 | $4,677.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $489.78 / $2,344.23
| Professional | | $234.42 | $489.78 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $89.13 / $1,174.90
| Professional | 53 | $77.62 | $89.13 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $5,011.87 / $14,454.40
| Facility | | $2,630.27 | $5,011.87 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,148.15 / $2,630.27
| Professional | | $645.65 | $1,148.15 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,995.26 / $8,912.51
| Facility | | $323.59 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $2,041.74
| Professional | | $323.59 | $323.59 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15,488.17 / $18,197.01 / $22,387.21
| Facility | | $15,488.17 | $18,197.01 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | 22 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Facility | 52 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | 53 | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $812.83 / $4,466.84
| Professional | | $288.40 | $812.83 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $891.25 / $954.99 / $1,698.24
| Professional | 53 | $891.25 | $954.99 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $524.81 / $2,137.96
| Facility | | $239.88 | $524.81 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,737.80 / $2,630.27
| Professional | | $1,258.93 | $1,737.80 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,621.81 / $2,754.23
| Professional | | $338.84 | $1,621.81 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $5,128.61 / $7,413.10
| Facility | | $2,454.71 | $5,128.61 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $562.34
| Professional | | $323.59 | $323.59 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $50,118.72 / $75,857.76
| Facility | | $281.84 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,819.70 / $2,951.21
| Professional | | $398.11 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $812.83 / $954.99 / $1,698.24
| Professional | 53 | $812.83 | $954.99 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,265.80 / $10,471.29
| Facility | | $2,137.96 | $4,265.80 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,288.25 / $2,884.03
| Professional | | $257.04 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $954.99
| Facility | | $186.21 | $263.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,348.96 / $2,630.27
| Professional | | $338.84 | $1,348.96 | $2,630.27 |