- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $2,089.30 / $3,715.35
| Facility | | $199.53 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $190.55 / $512.86
| Professional | | $79.43 | $190.55 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,000.00 / $2,951.21
| Facility | | $56.23 | $1,000.00 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | 53 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $218.78 / $1,621.81
| Professional | | $91.20 | $218.78 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $223.87
| Facility | | $95.50 | $95.50 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $223.87 / $512.86
| Professional | | $95.50 | $223.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $208.93 / $467.74
| Professional | | $104.71 | $208.93 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $107.15 / $3,311.31
| Facility | | $79.43 | $107.15 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $263.03 / $426.58
| Professional | | $204.17 | $263.03 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $199.53 / $457.09
| Professional | | $87.10 | $199.53 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $1,584.89
| Facility | | $954.99 | $954.99 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $131.83
| Professional | | $128.82 | $128.82 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,000.00 / $2,951.21
| Facility | | $56.23 | $1,000.00 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | 53 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $218.78 / $1,621.81
| Professional | | $91.20 | $218.78 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $218.78 / $478.63
| Professional | | $93.33 | $218.78 | $478.63 |