- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $2,454.71 / $3,801.89
| Facility | | $645.65 | $2,454.71 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | 52 | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $162.18 / $4,897.79
| Facility | 53 | $77.62 | $162.18 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $354.81 / $954.99
| Professional | | $173.78 | $354.81 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $151.36 / $281.84
| Professional | 53 | $83.18 | $151.36 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $3,467.37 / $3,548.13
| Facility | | $1,096.48 | $3,467.37 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $645.65 / $1,202.26
| Professional | | $331.13 | $645.65 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,258.93 / $3,019.95
| Facility | | $794.33 | $1,258.93 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $691.83 / $1,348.96
| Professional | | $338.84 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $363.08
| Professional | 53 | $144.54 | $213.80 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,230.27 / $2,344.23
| Facility | | $977.24 | $1,230.27 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $676.08 / $1,230.27
| Professional | | $371.54 | $676.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,023.29 / $2,884.03
| Facility | | $281.84 | $1,023.29 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,995.26
| Facility | 53 | $1,071.52 | $1,071.52 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $676.08 / $1,479.11
| Professional | | $380.19 | $676.08 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $204.17 / $354.81 / $1,479.11
| Professional | 53 | $204.17 | $354.81 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,630.27 / $4,897.79
| Facility | | $1,584.89 | $2,630.27 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $457.09 / $1,047.13
| Professional | | $213.80 | $457.09 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $549.54
| Professional | 53 | $100.00 | $147.91 | $549.54 |