- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $2,570.40 / $5,754.40
| Facility | | $467.74 | $2,570.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $1,778.28
| Facility | 52 | $707.95 | $707.95 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $398.11 / $707.95
| Professional | | $194.98 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $93.33 / $199.53 / $512.86
| Professional | 52 | $93.33 | $199.53 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $97.72 / $204.17 / $204.17
| Professional | 53 | $97.72 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $213.80 / $251.19
| Professional | | $173.78 | $213.80 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $22.91 / $50.12 / $57.54
| Professional | 52 | $22.91 | $50.12 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,584.89 / $2,238.72
| Facility | | $1,148.15 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $416.87 / $575.44
| Professional | | $194.98 | $416.87 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $676.08
| Professional | | $208.93 | $380.19 | $676.08 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $489.78 / $2,570.40
| Facility | | $213.80 | $489.78 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | 52 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | 53 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $537.03 / $3,235.94
| Professional | | $331.13 | $537.03 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $8.91
| Professional | 52 | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,995.26 / $3,162.28
| Facility | | $524.81 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $346.74 / $588.84
| Professional | | $186.21 | $346.74 | $588.84 |