- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $1,122.02 / $7,079.46
| Facility | | $109.65 | $1,122.02 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $125.89 / $316.23 / $912.01
| Facility | 52 | $125.89 | $316.23 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $114.82 / $446.68 / $776.25
| Facility | 53 | $114.82 | $446.68 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $134.90 / $354.81
| Professional | | $72.44 | $134.90 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $60.26 / $112.20 / $281.84
| Professional | 52 | $60.26 | $112.20 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $25.12 / $47.86 / $102.33
| Professional | 53 | $25.12 | $47.86 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $239.88
| Professional | | $72.44 | $123.03 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $323.59 / $891.25
| Facility | | $53.70 | $323.59 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | 52 | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Facility | 53 | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $134.90 / $263.03
| Professional | | $79.43 | $134.90 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $63.10 / $67.61 / $234.42
| Professional | 53 | $63.10 | $67.61 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $1,000.00 / $3,311.31
| Facility | | $181.97 | $1,000.00 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $117.49 / $204.17
| Professional | | $69.18 | $117.49 | $204.17 |