- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,951.21 / $6,918.31
| Facility | | $676.08 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 52 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $54.95 / $104.71 / $162.18
| Facility | 53 | $54.95 | $104.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $323.59 / $851.14
| Professional | | $165.96 | $323.59 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $66.07 / $120.23 / $239.88
| Professional | 53 | $66.07 | $120.23 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $363.08
| Professional | | $162.18 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $81.28 / $100.00 / $173.78
| Professional | 53 | $81.28 | $100.00 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $489.78 / $1,202.26
| Facility | | $120.23 | $489.78 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $186.21 / $407.38
| Professional | | $89.13 | $186.21 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $489.78 / $954.99
| Facility | | $371.54 | $489.78 | $954.99 |
- 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 / $467.74
| Facility | 53 | $74.13 | $74.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $75.86 / $131.83 / $245.47
| Professional | 53 | $75.86 | $131.83 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,630.27 / $6,309.57
| Facility | | $549.54 | $2,630.27 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $346.74 / $467.74
| Professional | | $190.55 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $64.57 / $131.83 / $218.78
| Professional | 53 | $64.57 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $194.98
| Professional | | $32.36 | $33.11 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $2,187.76 / $5,011.87
| Facility | | $501.19 | $2,187.76 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $288.40 / $549.54
| Professional | | $162.18 | $288.40 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $100.00 / $204.17 / $346.74
| Professional | 53 | $100.00 | $204.17 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $389.05
| Professional | | $151.36 | $281.84 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $75.86 / $141.25 / $194.98
| Professional | 53 | $75.86 | $141.25 | $194.98 |