- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $2,041.74 / $6,309.57
| Facility | | $630.96 | $2,041.74 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $478.63 / $1,348.96
| Professional | | $245.47 | $478.63 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $467.74
| Professional | 53 | $104.71 | $151.36 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $239.88 / $371.54
| Professional | | $199.53 | $239.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Professional | 53 | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,995.26 / $3,981.07
| Facility | | $549.54 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $954.99
| Professional | | $263.03 | $436.52 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $707.95 / $1,174.90
| Facility | | $446.68 | $707.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $467.74 / $794.33
| Professional | | $269.15 | $467.74 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $467.74 / $1,318.26
| Facility | | $257.04 | $467.74 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $2,691.53
| Facility | 52 | $912.01 | $912.01 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $676.08
| Facility | 53 | $229.09 | $229.09 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $676.08 / $3,467.37
| Professional | | $416.87 | $676.08 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,445.44
| Professional | 53 | $1,412.54 | $1,412.54 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,584.89 / $4,466.84
| Facility | | $1,000.00 | $1,584.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $436.52 / $758.58
| Professional | | $251.19 | $436.52 | $758.58 |