- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,801.89 / $7,244.36
| Facility | | $758.58 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,202.26 / $1,819.70 / $3,235.94
| Facility | 52 | $1,202.26 | $1,819.70 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Facility | 53 | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $181.97 / $501.19
| Professional | | $95.50 | $181.97 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $91.20 / $263.03
| Professional | | $77.62 | $91.20 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $4,466.84 / $10,232.93
| Facility | | $2,089.30 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $100.00 / $281.84
| Professional | | $93.33 | $100.00 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $275.42 / $616.60
| Professional | | $114.82 | $275.42 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $588.84
| Professional | | $275.42 | $398.11 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $3,019.95 / $4,677.35
| Facility | | $1,905.46 | $3,019.95 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $275.42 / $616.60
| Professional | | $87.10 | $275.42 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $4,897.79 / $8,317.64
| Facility | | $1,949.84 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $239.88 / $562.34
| Professional | | $85.11 | $239.88 | $562.34 |