- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $1,023.29 / $5,248.07
| Facility | | $208.93 | $1,023.29 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Facility | 52 | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $60.26 / $123.03 / $158.49
| Facility | 53 | $60.26 | $123.03 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $316.23 / $812.83
| Professional | | $165.96 | $316.23 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $60.26 / $128.82 / $234.42
| Professional | 53 | $60.26 | $128.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $204.17 / $229.09
| Professional | | $177.83 | $204.17 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,412.54 / $3,467.37
| Facility | | $1,288.25 | $1,412.54 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $380.19 / $645.65
| Professional | | $165.96 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $323.59
| Professional | 53 | $83.18 | $190.55 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | 53 | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $3,630.78 / $7,943.28
| Facility | | $691.83 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $436.52 / $891.25
| Professional | | $208.93 | $436.52 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $3,630.78 / $7,943.28
| Facility | | $691.83 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $436.52 / $891.25
| Professional | | $213.80 | $436.52 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $346.74
| Professional | 53 | $125.89 | $239.88 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $131.83 / $660.69
| Facility | | $114.82 | $131.83 | $660.69 |