- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $2,630.27 / $5,623.41
| Facility | | $309.03 | $2,630.27 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $218.78
| Facility | 53 | $91.20 | $134.90 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $245.47 / $407.38
| Professional | | $151.36 | $245.47 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $194.98
| Professional | 53 | $70.79 | $120.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $213.80 / $229.09
| Professional | | $208.93 | $213.80 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,584.89 / $2,238.72
| Facility | | $1,148.15 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $331.13 / $446.68
| Professional | | $177.83 | $331.13 | $446.68 |
- 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
- 53
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $251.19
| Professional | 53 | $147.91 | $147.91 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $354.81 / $1,348.96
| Facility | | $186.21 | $354.81 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | 52 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | 53 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $2,187.76
| Professional | | $288.40 | $416.87 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,318.26 / $2,511.89
| Facility | | $371.54 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $478.63
| Professional | | $173.78 | $288.40 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $125.89
| Professional | 53 | $60.26 | $60.26 | $125.89 |