- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,621.81 / $3,090.30
| Facility | | $389.05 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $60.26 / $125.89 / $2,884.03
| Facility | 53 | $60.26 | $125.89 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $794.33
| Professional | | $169.82 | $316.23 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $66.07 / $117.49 / $194.98
| Professional | 53 | $66.07 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $245.47 / $354.81
| Professional | | $147.91 | $245.47 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $144.54 / $158.49
| Professional | 53 | $77.62 | $144.54 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,137.96 / $2,951.21
| Facility | | $954.99 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $707.95
| Professional | | $218.78 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $173.78 / $309.03
| Professional | 53 | $91.20 | $173.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $588.84 / $1,047.13
| Facility | | $457.09 | $588.84 | $1,047.13 |
- 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
- $64.57 / $138.04 / $245.47
| Professional | 53 | $64.57 | $138.04 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $28,840.32
| Facility | | $2,884.03 | $2,884.03 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 52 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | 53 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,818.38 / $2,818.38
| Professional | | $2,187.76 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,348.96 / $2,884.03
| Facility | | $645.65 | $1,348.96 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $323.59 / $602.56
| Professional | | $181.97 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $66.07 / $79.43 / $141.25
| Professional | 53 | $66.07 | $79.43 | $141.25 |