- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,630.27 / $5,888.44
| Facility | | $489.78 | $2,630.27 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,071.52 / $2,570.40 / $5,128.61
| Facility | 52 | $1,071.52 | $2,570.40 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $93.33 / $169.82 / $316.23
| Facility | 53 | $93.33 | $169.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $346.74 / $954.99
| Professional | | $177.83 | $346.74 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $309.03
| Professional | 53 | $83.18 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $363.08
| Professional | | $162.18 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $117.49
| Professional | 53 | $70.79 | $93.33 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,348.96 / $3,981.07
| Facility | | $1,023.29 | $1,348.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $371.54 / $602.56
| Professional | | $208.93 | $371.54 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,698.24 / $2,754.23
| Facility | | $954.99 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $363.08 / $691.83
| Professional | | $204.17 | $363.08 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $102.33 / $213.80 / $363.08
| Professional | 53 | $102.33 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $524.81 / $1,949.84
| Professional | | $245.47 | $524.81 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $229.09 / $446.68
| Professional | | $213.80 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $363.08
| Professional | | $32.36 | $33.11 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,187.76 / $4,365.16
| Facility | | $794.33 | $2,187.76 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $354.81 / $676.08
| Professional | | $194.98 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $112.20 / $194.98 / $371.54
| Professional | 53 | $112.20 | $194.98 | $371.54 |