- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $1,905.46 / $3,981.07
| Facility | | $48.98 | $1,905.46 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $588.84 / $954.99
| Facility | | $512.86 | $588.84 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | 53 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $165.96 / $2,818.38
| Facility | | $50.12 | $165.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $165.96 / $2,951.21
| Facility | | $51.29 | $165.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,019.95 / $3,235.94
| Facility | | $1,819.70 | $3,019.95 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $257.04 / $691.83
| Professional | | $95.50 | $257.04 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $575.44 / $954.99
| Facility | | $123.03 | $575.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $24.55 / $114.82 / $169.82
| Facility | 53 | $24.55 | $114.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $229.09
| Professional | | $66.07 | $66.07 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,754.23 / $5,011.87
| Facility | | $2,344.23 | $2,754.23 | $5,011.87 |