- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $2,511.89 / $7,244.36
| Facility | | $380.19 | $2,511.89 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $660.69 / $1,023.29 / $2,570.40
| Facility | 52 | $660.69 | $1,023.29 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | 53 | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $223.87 / $724.44
| Professional | | $81.28 | $223.87 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $5,128.61 / $12,022.64
| Facility | | $1,862.09 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $354.81 / $831.76
| Professional | | $87.10 | $354.81 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,445.44 / $21,877.62
| Facility | | $141.25 | $1,445.44 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | 52 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | 53 | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $309.03 / $933.25
| Professional | | $97.72 | $309.03 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $2,691.53 / $6,760.83
| Facility | | $1,096.48 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $331.13 / $776.25
| Professional | | $87.10 | $331.13 | $776.25 |