- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $2,454.71 / $4,073.80
| Facility | | $331.13 | $2,454.71 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $87.10 / $141.25 / $169.82
| Facility | 53 | $87.10 | $141.25 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $331.13 / $933.25
| Professional | | $169.82 | $331.13 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $60.26 / $120.23 / $229.09
| Professional | 53 | $60.26 | $120.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $724.44 / $870.96
| Professional | | $588.84 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $467.74
| Professional | 53 | $316.23 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $467.74
| Professional | | $194.98 | $302.00 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $41.69 / $208.93 / $389.05
| Professional | 53 | $41.69 | $208.93 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $346.74 / $1,698.24
| Facility | | $186.21 | $346.74 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $537.03 / $2,187.76
| Professional | | $338.84 | $537.03 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,819.70 / $2,570.40
| Facility | | $446.68 | $1,819.70 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $354.81 / $707.95
| Professional | | $173.78 | $354.81 | $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 |