- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,949.84 / $5,495.41
| Facility | | $645.65 | $1,949.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $426.58 / $794.33
| Professional | | $245.47 | $426.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $190.55
| Professional | 53 | $114.82 | $162.18 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $309.03 / $426.58
| Facility | | $245.47 | $309.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $489.78 / $977.24
| Professional | | $407.38 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $1,659.59
| Facility | | $426.58 | $426.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | 22 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | 52 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | 53 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $478.63 / $3,548.13
| Professional | | $257.04 | $478.63 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,398.83 / $6,025.60
| Facility | | $891.25 | $2,398.83 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $309.03 / $467.74
| Professional | | $281.84 | $309.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | 53 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,230.27 / $3,311.31
| Facility | | $724.44 | $1,230.27 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $416.87 / $794.33
| Professional | | $223.87 | $416.87 | $794.33 |