- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $2,238.72 / $6,165.95
| Facility | | $190.55 | $2,238.72 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $57.54 / $95.50 / $173.78
| Facility | 53 | $57.54 | $95.50 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $302.00 / $501.19
| Professional | | $162.18 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $61.66 / $117.49 / $199.53
| Professional | 53 | $61.66 | $117.49 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $169.82 / $269.15
| Facility | | $24.55 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $208.93 / $724.44
| Professional | | $40.74 | $208.93 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $1,862.09
| Facility | | $371.54 | $371.54 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 22 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | 52 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Facility | 53 | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $1,584.89
| Professional | | $302.00 | $302.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $2,884.03 / $5,011.87
| Facility | | $457.09 | $2,884.03 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $380.19 / $416.87
| Professional | | $213.80 | $380.19 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $218.78 / $251.19 / $346.74
| Professional | 53 | $218.78 | $251.19 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $2,570.40
| Facility | | $691.83 | $691.83 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $302.00 / $575.44
| Professional | | $162.18 | $302.00 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | 53 | $204.17 | $204.17 | $204.17 |