- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,148.15 / $2,884.03
| Facility | | $141.25 | $1,148.15 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Facility | 52 | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | 53 | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $223.87 / $630.96
| Professional | | $100.00 | $223.87 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $107.15 / $190.55
| Professional | | $85.11 | $107.15 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $165.96 / $457.09
| Professional | | $158.49 | $165.96 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $181.97
| Facility | | $100.00 | $128.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $346.74 / $602.56
| Professional | | $251.19 | $346.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $257.04 / $537.03
| Professional | | $109.65 | $257.04 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,023.29 / $2,884.03
| Facility | | $141.25 | $1,023.29 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Facility | 52 | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | 53 | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $288.40 / $562.34
| Professional | | $104.71 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $239.88 / $426.58
| Professional | | $104.71 | $239.88 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,778.28 / $5,623.41
| Facility | | $724.44 | $1,778.28 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $263.03 / $478.63
| Professional | | $109.65 | $263.03 | $478.63 |