- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $3,311.31 / $7,585.78
| Facility | | $295.12 | $3,311.31 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $912.01 / $1,023.29
| Facility | | $794.33 | $912.01 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $891.25 / $1,584.89
| Facility | | $489.78 | $891.25 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | 52 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | 53 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 62 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Facility | AS | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Professional | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $489.78
| Facility | | $194.98 | $281.84 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,398.83 / $5,623.41
| Facility | | $398.11 | $2,398.83 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $28,840.32
| Facility | | $5,011.87 | $5,011.87 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | 52 | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 53 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | 62 | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | AS | $501.19 | $501.19 | $501.19 |