- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $3,630.78 / $6,165.95
| Facility | | $851.14 | $3,630.78 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | 52 | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $81.28 / $154.88 / $2,754.23
| Facility | 53 | $81.28 | $154.88 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $316.23 / $812.83
| Professional | | $165.96 | $316.23 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $134.90 / $234.42
| Professional | 53 | $74.13 | $134.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $338.84
| Professional | | $162.18 | $213.80 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $107.15 / $162.18
| Professional | 53 | $85.11 | $107.15 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $3,981.07
| Facility | | $676.08 | $1,819.70 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $371.54 / $724.44
| Professional | | $208.93 | $371.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $169.82 / $281.84
| Professional | 53 | $91.20 | $169.82 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $186.21 / $295.12
| Facility | | $30.90 | $186.21 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $169.82 / $478.63
| Professional | | $40.74 | $169.82 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $630.96 / $2,691.53
| Facility | | $501.19 | $630.96 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $389.05
| Professional | | $302.00 | $302.00 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $41.69 / $151.36 / $912.01
| Professional | 53 | $41.69 | $151.36 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $389.05 / $691.83
| Professional | | $169.82 | $389.05 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $380.19 / $416.87 / $776.25
| Professional | 22 | $380.19 | $416.87 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $109.65 / $123.03 / $223.87
| Professional | 52 | $109.65 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $194.98 / $281.84
| Professional | 53 | $85.11 | $194.98 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,884.03 / $2,884.03
| Facility | | $1,148.15 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $316.23 / $812.83
| Professional | | $107.15 | $316.23 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,548.82 / $2,818.38
| Facility | | $407.38 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $346.74 / $660.69
| Professional | | $190.55 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $89.13 / $204.17 / $338.84
| Professional | 53 | $89.13 | $204.17 | $338.84 |