- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $1,905.46 / $7,079.46
| Facility | | $169.82 | $1,905.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $177.83 / $323.59
| Facility | 53 | $83.18 | $177.83 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,090.30 / $5,754.40
| Facility | | $2,238.72 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $977.24 / $1,584.89
| Facility | | $851.14 | $977.24 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | 53 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $346.74 / $2,754.23
| Facility | | $158.49 | $346.74 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $354.81 / $3,630.78
| Facility | | $162.18 | $354.81 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | 53 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $3,890.45 / $4,570.88
| Facility | | $331.13 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $524.81 / $1,174.90
| Professional | | $251.19 | $524.81 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $2,754.23 / $2,754.23
| Facility | | $263.03 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $52.48 / $380.19 / $549.54
| Facility | 53 | $52.48 | $380.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $1,202.26
| Professional | | $562.34 | $562.34 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $295.12
| Professional | 53 | $141.25 | $141.25 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,311.31 / $6,606.93
| Facility | | $2,630.27 | $3,311.31 | $6,606.93 |