- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $2,290.87 / $4,786.30
| Facility | | $269.15 | $2,290.87 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $134.90 / $151.36 / $331.13
| Facility | 53 | $134.90 | $151.36 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $346.74 / $1,096.48
| Professional | | $177.83 | $346.74 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $154.88 / $323.59
| Professional | 53 | $83.18 | $154.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $162.18 / $213.80
| Professional | | $147.91 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $100.00
| Professional | 53 | $63.10 | $79.43 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $2,884.03 / $4,897.79
| Facility | | $616.60 | $2,884.03 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $346.74 / $436.52
| Professional | | $218.78 | $346.74 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $371.54 / $616.60
| Professional | | $218.78 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $478.63
| Professional | | $32.36 | $33.11 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $380.19 / $691.83
| Facility | | $199.53 | $380.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $389.05 / $676.08
| Professional | | $218.78 | $389.05 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,235.94 / $4,570.88
| Facility | | $758.58 | $3,235.94 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $645.65
| Professional | | $229.09 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $144.54 / $239.88 / $478.63
| Professional | 53 | $144.54 | $239.88 | $478.63 |