- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $977.24 / $3,388.44
| Facility | | $204.17 | $977.24 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $2,290.87
| Facility | 52 | $234.42 | $389.05 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $100.00 / $194.98 / $263.03
| Facility | 53 | $100.00 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $389.05 / $1,318.26
| Professional | | $181.97 | $389.05 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $302.00
| Professional | 53 | $83.18 | $158.49 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $194.98 / $380.19
| Professional | | $177.83 | $194.98 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $524.81 / $660.69
| Facility | | $457.09 | $524.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $323.59 / $588.84
| Professional | | $190.55 | $323.59 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $138.04 / $218.78 / $323.59
| Professional | 53 | $138.04 | $218.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $426.58 / $588.84
| Professional | | $257.04 | $426.58 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $257.04 / $426.58 / $588.84
| Professional | 53 | $257.04 | $426.58 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $1,445.44
| Facility | | $416.87 | $575.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $316.23 / $575.44
| Professional | | $177.83 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $112.20 / $229.09 / $660.69
| Professional | 53 | $112.20 | $229.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $426.58 / $575.44
| Professional | | $181.97 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $208.93 / $257.04 / $288.40
| Professional | 53 | $208.93 | $257.04 | $288.40 |