- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $1,698.24 / $5,888.44
| Facility | | $275.42 | $1,698.24 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $89.13 / $151.36 / $257.04
| Facility | 53 | $89.13 | $151.36 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $851.14
| Professional | | $169.82 | $316.23 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $72.44 / $131.83 / $245.47
| Professional | 53 | $72.44 | $131.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $234.42 / $501.19
| Professional | | $194.98 | $234.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $549.54 / $933.25
| Professional | | $281.84 | $549.54 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $575.44 / $891.25
| Facility | | $478.63 | $575.44 | $891.25 |
- 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
- $302.00 / $302.00 / $436.52
| Professional | | $302.00 | $302.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $158.49 / $169.82 / $229.09
| Professional | 53 | $158.49 | $169.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Professional | 53 | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $338.84 / $588.84
| Facility | | $181.97 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $851.14
| Professional | | $302.00 | $302.00 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $478.63
| Professional | 53 | $426.58 | $426.58 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $2,691.53
| Facility | | $1,288.25 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $263.03 / $478.63
| Professional | | $128.82 | $263.03 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,479.11 / $3,311.31
| Facility | | $257.04 | $1,479.11 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $323.59 / $588.84
| Professional | | $181.97 | $323.59 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $107.15 / $239.88 / $338.84
| Professional | 53 | $107.15 | $239.88 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $28,840.32
| Facility | | $2,884.03 | $2,884.03 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 52 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | 53 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,818.38
| Professional | | $2,187.76 | $2,187.76 | $2,818.38 |