- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $3,801.89 / $4,897.79
| Facility | | $239.88 | $3,801.89 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $331.13
| Facility | 53 | $109.65 | $151.36 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $269.15 / $933.25
| Professional | | $147.91 | $269.15 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $213.80
| Professional | 53 | $67.61 | $120.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $181.97
| Professional | | $162.18 | $162.18 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | 53 | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $2,754.23 / $4,365.16
| Facility | | $562.34 | $2,754.23 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $436.52
| Professional | | $218.78 | $331.13 | $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
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $346.74
| Professional | | $32.36 | $33.11 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $338.84 / $588.84
| Facility | | $169.82 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $851.14
| Professional | | $302.00 | $302.00 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,454.71 / $3,019.95
| Facility | | $524.81 | $2,454.71 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $371.54 / $645.65
| Professional | | $229.09 | $371.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $144.54 / $239.88 / $501.19
| Professional | 53 | $144.54 | $239.88 | $501.19 |