- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,570.40 / $5,248.07
| Facility | | $676.08 | $2,570.40 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $851.14 / $1,230.27 / $2,884.03
| Facility | 52 | $851.14 | $1,230.27 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $436.52 / $1,000.00
| Professional | | $194.98 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $194.98 / $223.87 / $1,122.02
| Professional | 52 | $194.98 | $223.87 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $131.83 / $524.81
| Professional | 53 | $69.18 | $131.83 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $190.55 / $363.08
| Professional | | $173.78 | $190.55 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $478.63
| Professional | 52 | $44.67 | $52.48 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $169.82 / $177.83 / $190.55
| Professional | 53 | $169.82 | $177.83 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,548.82 / $3,162.28
| Facility | | $891.25 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $309.03 / $537.03
| Professional | | $173.78 | $309.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,174.90 / $3,548.13
| Facility | | $512.86 | $1,174.90 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $190.55 / $602.56
| Professional | | $53.70 | $190.55 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,122.02 / $1,122.02
| Facility | | $177.83 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $851.14 / $1,412.54
| Facility | | $467.74 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $426.58 / $776.25
| Professional | | $223.87 | $426.58 | $776.25 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $28,840.32 / $28,840.32
| Facility | | $3,715.35 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | 52 | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Facility | 53 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $3,162.28 / $3,630.78
| Professional | | $269.15 | $3,162.28 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $537.03 / $2,951.21
| Facility | | $218.78 | $537.03 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $851.14 / $1,230.27 / $2,884.03
| Facility | 52 | $851.14 | $1,230.27 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $436.52 / $870.96
| Professional | | $199.53 | $436.52 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $173.78 / $218.78 / $616.60
| Professional | 52 | $173.78 | $218.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $123.03 / $251.19
| Professional | 53 | $69.18 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $363.08
| Professional | | $32.36 | $33.11 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,884.03 / $2,884.03
| Facility | | $1,380.38 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $645.65 / $1,659.59
| Professional | | $190.55 | $645.65 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $467.74 / $851.14
| Facility | | $208.93 | $467.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $436.52 / $812.83
| Professional | | $218.78 | $436.52 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,995.26 / $3,981.07
| Facility | | $724.44 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $371.54 / $645.65
| Professional | | $190.55 | $371.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $457.09 / $524.81
| Professional | | $151.36 | $457.09 | $524.81 |