- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $2,754.23 / $6,760.83
| Facility | | $457.09 | $2,754.23 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,905.46
| Facility | 52 | $1,584.89 | $1,584.89 | $1,905.46 |
- 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
- $158.49 / $269.15 / $1,000.00
| Professional | 52 | $158.49 | $269.15 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $93.33 / $158.49 / $245.47
| Professional | 53 | $93.33 | $158.49 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $257.04 / $416.87
| Professional | | $190.55 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $229.09 / $1,995.26
| Professional | | $190.55 | $229.09 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $616.60 / $1,023.29
| Facility | | $426.58 | $616.60 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | 22 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | 52 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | 53 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $407.38 / $724.44
| Professional | | $229.09 | $407.38 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Professional | 53 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $575.44 / $954.99
| Professional | | $446.68 | $575.44 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $660.69 / $831.76
| Professional | | $575.44 | $660.69 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $457.09 / $831.76
| Facility | | $229.09 | $457.09 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $1,023.29
| Professional | | $446.68 | $446.68 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $977.24
| Facility | | $204.17 | $302.00 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $575.44 / $1,819.70
| Professional | | $436.52 | $575.44 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,511.89 / $5,370.32
| Facility | | $575.44 | $2,511.89 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $389.05 / $724.44
| Professional | | $194.98 | $389.05 | $724.44 |