- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $2,041.74 / $6,606.93
| Facility | | $141.25 | $2,041.74 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $416.87 / $1,122.02 / $3,311.31
| Facility | 52 | $416.87 | $1,122.02 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,122.02 / $1,318.26 / $2,041.74
| Facility | 53 | $1,122.02 | $1,318.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $134.90 / $380.19
| Professional | | $53.70 | $134.90 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $3,548.13 / $8,912.51
| Facility | | $1,348.96 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $128.82 / $295.12
| Professional | | $57.54 | $128.82 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $338.84 / $1,412.54
| Facility | | $95.50 | $338.84 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | 52 | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Facility | 53 | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $158.49 / $389.05
| Professional | | $63.10 | $158.49 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,659.59 / $4,265.80
| Facility | | $478.63 | $1,659.59 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $138.04 / $331.13
| Professional | | $53.70 | $138.04 | $331.13 |