- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $2,398.83 / $6,606.93
| Facility | | $407.38 | $2,398.83 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $724.44 / $1,380.38 / $1,819.70
| Facility | 52 | $724.44 | $1,380.38 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $309.03
| Facility | 53 | $100.00 | $169.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $977.24
| Professional | | $181.97 | $354.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $288.40
| Professional | 53 | $83.18 | $162.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $275.42
| Professional | | $154.88 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $117.49
| Professional | 53 | $57.54 | $91.20 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,454.71 / $4,466.84
| Facility | | $776.25 | $2,454.71 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $257.04 / $457.09
| Professional | | $186.21 | $257.04 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $169.82
| Professional | 53 | $79.43 | $100.00 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $251.19 / $295.12
| Professional | | $194.98 | $251.19 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $147.91
| Professional | 53 | $97.72 | $125.89 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $173.78 / $269.15
| Facility | | $24.55 | $173.78 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $208.93 / $501.19
| Professional | | $41.69 | $208.93 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $524.81 / $812.83
| Facility | | $309.03 | $524.81 | $812.83 |
- 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
- $199.53 / $338.84 / $645.65
| Professional | | $199.53 | $338.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $67.61 / $144.54 / $457.09
| Professional | 53 | $67.61 | $144.54 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,698.24 / $3,715.35
| Facility | | $741.31 | $1,698.24 | $3,715.35 |
- 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
- $177.83 / $295.12 / $588.84
| Professional | | $177.83 | $295.12 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $29.51 / $66.07 / $457.09
| Professional | 53 | $29.51 | $66.07 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $102.33
| Professional | | $32.36 | $33.11 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $562.34 / $645.65
| Facility | | $100.00 | $562.34 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $575.44
| Facility | 53 | $100.00 | $100.00 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $371.54 / $562.34
| Professional | | $177.83 | $371.54 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $186.21 / $281.84
| Professional | 53 | $85.11 | $186.21 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,187.76 / $4,897.79
| Facility | | $707.95 | $2,187.76 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $309.03 / $537.03
| Professional | | $173.78 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $79.43 / $288.40 / $389.05
| Professional | 53 | $79.43 | $288.40 | $389.05 |