- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $2,754.23 / $5,888.44
| Facility | | $933.25 | $2,754.23 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $354.81
| Facility | 53 | $204.17 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $562.34
| Professional | | $162.18 | $295.12 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $70.79 / $123.03 / $229.09
| Professional | 53 | $70.79 | $123.03 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $389.05 / $1,584.89
| Facility | | $199.53 | $389.05 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $354.81
| Facility | 53 | $204.17 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $616.60 / $1,659.59
| Professional | | $234.42 | $616.60 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $158.49 / $323.59
| Professional | 53 | $74.13 | $158.49 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,096.48 / $1,584.89
| Professional | | $724.44 | $1,096.48 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $354.81 / $630.96
| Facility | | $194.98 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $407.38 / $794.33
| Professional | | $257.04 | $407.38 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $354.81 / $1,122.02
| Professional | | $177.83 | $354.81 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $169.82 / $288.40 / $346.74
| Professional | 53 | $169.82 | $288.40 | $346.74 |