- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $6,918.31 / $10,000.00
| Facility | | $3,467.37 | $6,918.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $501.19 / $2,630.27
| Professional | | $234.42 | $501.19 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $77.62 / $1,174.90
| Professional | 53 | $69.18 | $77.62 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $302.00 / $407.38
| Facility | | $239.88 | $302.00 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $2,570.40 / $2,691.53
| Professional | | $269.15 | $2,570.40 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $1,862.09
| Facility | | $398.11 | $398.11 | $1,862.09 |
- 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
- $257.04 / $776.25 / $5,754.40
| Professional | | $257.04 | $776.25 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $12,302.69 / $15,488.17
| Facility | | $3,235.94 | $12,302.69 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $9,120.11
| Facility | | $2,454.71 | $2,454.71 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $346.74 / $1,230.27
| Professional | | $213.80 | $346.74 | $1,230.27 |