- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,398.83 / $6,025.60
| Facility | | $489.78 | $2,398.83 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | 52 | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $724.44
| Professional | | $245.47 | $436.52 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | 53 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $275.42 / $309.03
| Professional | | $213.80 | $275.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | 53 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,467.37 / $5,495.41
| Facility | | $2,187.76 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $602.56
| Professional | | $245.47 | $436.52 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $741.31
| Professional | | $245.47 | $457.09 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Professional | 53 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $524.81 / $2,570.40
| Facility | | $275.42 | $524.81 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $912.01
| Facility | 52 | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 53 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $575.44 / $3,467.37
| Professional | | $380.19 | $575.44 | $3,467.37 |
- 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
- $239.88 / $389.05 / $645.65
| Professional | | $239.88 | $389.05 | $645.65 |