- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,995.26 / $10,000.00
| Facility | | $251.19 | $1,995.26 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $223.87 / $537.03
| Professional | | $77.62 | $223.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $158.49
| Professional | 52 | $45.71 | $85.11 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $26.30 / $34.67 / $34.67
| Professional | 53 | $26.30 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $234.42 / $371.54
| Professional | | $100.00 | $234.42 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,479.11 / $2,041.74
| Facility | | $691.83 | $1,479.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $208.93 / $407.38
| Professional | | $114.82 | $208.93 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $213.80 / $346.74
| Professional | | $93.33 | $213.80 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,290.87 / $19,498.45
| Facility | | $1,995.26 | $2,290.87 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | 52 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | 53 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,862.09 / $1,862.09
| Professional | | $1,584.89 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,412.54 / $2,884.03
| Facility | | $707.95 | $1,412.54 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $199.53 / $398.11
| Professional | | $95.50 | $199.53 | $398.11 |