- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,819.70 / $5,011.87
| Facility | | $295.12 | $1,819.70 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,819.70 / $2,691.53 / $2,691.53
| Facility | 52 | $1,819.70 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $323.59
| Facility | 53 | $107.15 | $177.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $346.74 / $831.76
| Professional | | $177.83 | $346.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $154.88 / $269.15
| Professional | 53 | $83.18 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $194.98 / $275.42
| Professional | | $141.25 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $109.65
| Professional | 53 | $54.95 | $91.20 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,398.83 / $4,466.84
| Facility | | $1,479.11 | $2,398.83 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $204.17 / $524.81
| Professional | | $173.78 | $204.17 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $117.49 / $245.47
| Professional | 53 | $83.18 | $117.49 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $169.82 / $251.19
| Facility | | $23.44 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $213.80 / $426.58
| Professional | | $40.74 | $213.80 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $1,659.59
| Facility | | $309.03 | $309.03 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Facility | 22 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | 52 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | 53 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $389.05 / $2,884.03
| Professional | | $204.17 | $389.05 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $75.86 / $144.54 / $251.19
| Professional | 53 | $75.86 | $144.54 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $338.84
| Professional | | $32.36 | $33.11 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,041.74 / $3,801.89
| Facility | | $524.81 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $323.59 / $562.34
| Professional | | $181.97 | $323.59 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $141.25 / $281.84
| Professional | 53 | $69.18 | $141.25 | $281.84 |