- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,398.83 / $3,388.44
| Facility | | $446.68 | $2,398.83 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $223.87
| Facility | 53 | $83.18 | $158.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $354.81 / $933.25
| Professional | | $173.78 | $354.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $154.88 / $281.84
| Professional | 53 | $83.18 | $154.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $724.44 / $870.96
| Professional | | $616.60 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $331.13 / $398.11 / $467.74
| Professional | 53 | $331.13 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $446.68 / $912.01
| Professional | | $245.47 | $446.68 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $67.61 / $263.03 / $389.05
| Professional | 53 | $67.61 | $263.03 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $562.34 / $2,041.74
| Facility | | $223.87 | $562.34 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $1,348.96
| Professional | | $302.00 | $436.52 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $213.80
| Professional | 53 | $177.83 | $177.83 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,862.09 / $3,388.44
| Facility | | $676.08 | $1,862.09 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $707.95
| Professional | | $186.21 | $338.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $47.86 / $100.00 / $102.33
| Professional | 53 | $47.86 | $100.00 | $102.33 |