- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,122.02 / $4,897.79
| Facility | | $295.12 | $1,122.02 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $812.83
| Facility | 52 | $562.34 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $223.87 / $707.95
| Professional | | $97.72 | $223.87 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $147.91 / $489.78
| Professional | | $89.13 | $147.91 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $416.87 / $776.25
| Professional | | $165.96 | $416.87 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $588.84 / $912.01
| Facility | | $323.59 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Facility | 52 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | 53 | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $288.40 / $616.60
| Professional | | $125.89 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $269.15 / $489.78
| Facility | | $104.71 | $269.15 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $776.25
| Professional | | $177.83 | $177.83 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $2,187.76
| Facility | | $302.00 | $302.00 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $354.81 / $446.68
| Professional | | $147.91 | $354.81 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,398.83 / $6,165.95
| Facility | | $398.11 | $2,398.83 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $245.47 / $489.78
| Professional | | $102.33 | $245.47 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,818.38 / $2,818.38
| Facility | | $56.23 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | 52 | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | 53 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,398.83
| Professional | | $2,041.74 | $2,041.74 | $2,398.83 |