- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,041.74 / $5,623.41
| Facility | | $549.54 | $2,041.74 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | 52 | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $912.01
| Professional | | $245.47 | $436.52 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $812.83
| Professional | 53 | $186.21 | $186.21 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $239.88 / $363.08
| Professional | | $199.53 | $239.88 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | 53 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,412.54 / $1,819.70
| Facility | | $1,122.02 | $1,412.54 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $812.83
| Professional | | $588.84 | $588.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $870.96 / $2,454.71
| Facility | | $794.33 | $870.96 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $478.63 / $891.25
| Professional | | $281.84 | $478.63 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $562.34 / $2,187.76
| Facility | | $275.42 | $562.34 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $707.95 / $3,467.37
| Professional | | $446.68 | $707.95 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,174.90 / $3,162.28
| Facility | | $870.96 | $1,174.90 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $446.68 / $707.95
| Professional | | $263.03 | $446.68 | $707.95 |