- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $3,019.95 / $7,585.78
| Facility | | $851.14 | $3,019.95 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $575.44 / $1,000.00 / $2,630.27
| Facility | 52 | $575.44 | $1,000.00 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $426.58 / $1,000.00
| Professional | | $194.98 | $426.58 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $457.09
| Professional | 52 | $154.88 | $223.87 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $208.93
| Professional | 53 | $87.10 | $128.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $371.54
| Professional | | $169.82 | $208.93 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $173.78
| Professional | 52 | $22.91 | $22.91 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | 53 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,089.30 / $21,379.62
| Facility | | $1,174.90 | $2,089.30 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $524.81
| Professional | | $234.42 | $234.42 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $81.28
| Professional | 53 | $77.62 | $77.62 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $2,754.23 / $3,630.78
| Facility | | $338.84 | $2,754.23 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $446.68 / $933.25
| Professional | | $229.09 | $446.68 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Professional | 53 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $512.86 / $954.99
| Professional | | $239.88 | $512.86 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,801.89 / $6,025.60
| Facility | | $2,454.71 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $426.58 / $977.24
| Professional | | $158.49 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $5,011.87 / $8,317.64
| Facility | | $2,089.30 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $371.54 / $776.25
| Professional | | $165.96 | $371.54 | $776.25 |