- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $954.99 / $4,073.80
| Facility | | $181.97 | $954.99 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | 52 | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $173.78 / $446.68
| Facility | 53 | $85.11 | $173.78 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $363.08 / $851.14
| Professional | | $181.97 | $363.08 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $158.49 / $275.42
| Professional | 53 | $85.11 | $158.49 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $323.59 / $602.56
| Professional | | $177.83 | $323.59 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,862.09 / $6,918.31
| Facility | | $676.08 | $1,862.09 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Facility | 53 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $331.13 / $363.08
| Professional | | $186.21 | $331.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $141.25 / $186.21 / $316.23
| Professional | 53 | $141.25 | $186.21 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $416.87 / $1,318.26
| Facility | | $100.00 | $416.87 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $309.03 / $549.54
| Professional | | $173.78 | $309.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $100.00 / $204.17 / $338.84
| Professional | 53 | $100.00 | $204.17 | $338.84 |