- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,698.24 / $3,311.31
| Facility | | $338.84 | $1,698.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $245.47 / $1,380.38 / $1,445.44
| Facility | 52 | $245.47 | $1,380.38 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $213.80
| Facility | 53 | $91.20 | $120.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $933.25
| Professional | | $169.82 | $316.23 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $72.44 / $128.82 / $229.09
| Professional | 53 | $72.44 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $331.13
| Professional | | $162.18 | $199.53 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $81.28 / $87.10 / $123.03
| Professional | 53 | $81.28 | $87.10 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $295.12 / $537.03
| Professional | | $177.83 | $295.12 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $138.04 / $295.12
| Facility | | $24.55 | $138.04 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $112.20 / $478.63
| Professional | | $41.69 | $112.20 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $302.00 / $436.52
| Professional | | $269.15 | $302.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $89.13 / $173.78 / $363.08
| Professional | 53 | $89.13 | $173.78 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,659.59 / $3,388.44
| Facility | | $331.13 | $1,659.59 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $245.47 / $1,380.38 / $1,445.44
| Facility | 52 | $245.47 | $1,380.38 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $165.96 / $229.09
| Facility | 53 | $91.20 | $165.96 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $338.84 / $724.44
| Professional | | $177.83 | $338.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $81.28 / $151.36 / $251.19
| Professional | 53 | $81.28 | $151.36 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $501.19
| Professional | | $302.00 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $147.91 / $363.08 / $426.58
| Professional | 53 | $147.91 | $363.08 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,949.84 / $4,073.80
| Facility | | $645.65 | $1,949.84 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $562.34
| Professional | | $194.98 | $331.13 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $87.10 / $165.96 / $295.12
| Professional | 53 | $87.10 | $165.96 | $295.12 |