- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $4,466.84 / $10,000.00
| Facility | | $181.97 | $4,466.84 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | 52 | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $239.88
| Professional | | $72.44 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $69.18 / $100.00 / $134.90
| Professional | 52 | $69.18 | $100.00 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $29.51 / $44.67 / $56.23
| Professional | 53 | $29.51 | $44.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $173.78
| Professional | | $100.00 | $138.04 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $4,786.30 / $8,317.64
| Facility | | $537.03 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $281.84
| Professional | | $109.65 | $147.91 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $138.04 / $295.12
| Professional | | $74.13 | $138.04 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $213.80
| Professional | | $100.00 | $151.36 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $645.65 / $1,023.29
| Facility | | $407.38 | $645.65 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $102.33 / $251.19
| Professional | | $52.48 | $102.33 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,630.27 / $6,606.93
| Facility | | $1,318.26 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $109.65 / $186.21
| Professional | | $61.66 | $109.65 | $186.21 |