- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $3,548.13 / $7,413.10
| Facility | | $346.74 | $3,548.13 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | 53 | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $229.09 / $575.44
| Professional | | $81.28 | $229.09 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $45.71 / $158.49 / $239.88
| Professional | 52 | $45.71 | $158.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $26.30 / $34.67 / $34.67
| Professional | 53 | $26.30 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $125.89
| Professional | | $85.11 | $104.71 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $263.03 / $524.81
| Professional | | $102.33 | $263.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $251.19 / $537.03
| Professional | | $97.72 | $251.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $223.87 / $354.81
| Professional | | $25.70 | $223.87 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,137.96 / $3,388.44
| Facility | | $1,412.54 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $208.93 / $467.74
| Professional | | $66.07 | $208.93 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,548.13 / $6,606.93
| Facility | | $1,819.70 | $3,548.13 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $181.97 / $389.05
| Professional | | $63.10 | $181.97 | $389.05 |