- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,949.84 / $4,570.88
| Facility | | $331.13 | $1,949.84 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 52 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $323.59 / $1,778.28
| Professional | | $117.49 | $323.59 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $154.88 / $1,122.02
| Professional | | $131.83 | $154.88 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,479.11 / $3,235.94
| Facility | | $758.58 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $1,584.89
| Professional | | $173.78 | $288.40 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $1,122.02 / $1,659.59
| Professional | | $144.54 | $1,122.02 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,677.35
| Facility | | $1,698.24 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $1,778.28
| Professional | | $162.18 | $295.12 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $954.99 / $2,511.89
| Facility | | $158.49 | $954.99 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 52 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | 53 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,698.24 / $7,943.28
| Professional | | $199.53 | $1,698.24 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,513.56 / $2,884.03
| Facility | | $1,071.52 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $302.00 / $1,778.28
| Professional | | $147.91 | $302.00 | $1,778.28 |