- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $2,630.27 / $6,606.93
| Facility | | $354.81 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $436.52 / $2,511.89 / $3,162.28
| Facility | 52 | $436.52 | $2,511.89 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $144.54 / $281.84
| Facility | 53 | $74.13 | $144.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $812.83
| Professional | | $169.82 | $316.23 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $223.87
| Professional | 53 | $64.57 | $123.03 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $4,365.16 / $10,000.00
| Facility | | $1,698.24 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $346.74 / $645.65
| Professional | | $199.53 | $346.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $169.82 / $338.84
| Professional | 53 | $91.20 | $169.82 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $707.95 / $1,995.26
| Facility | | $371.54 | $707.95 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 22 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | 52 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Facility | 53 | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $302.00 / $436.52
| Professional | | $288.40 | $302.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $316.23
| Professional | 53 | $83.18 | $147.91 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,819.70 / $4,365.16
| Facility | | $478.63 | $1,819.70 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $346.74 / $691.83
| Professional | | $177.83 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $112.20 / $229.09 / $338.84
| Professional | 53 | $112.20 | $229.09 | $338.84 |