- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,318.26 / $2,511.89
| Facility | | $295.12 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $147.91
| Facility | 53 | $89.13 | $114.82 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $302.00 / $831.76
| Professional | | $165.96 | $302.00 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $64.57 / $117.49 / $199.53
| Professional | 53 | $64.57 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $194.98 / $239.88
| Professional | | $181.97 | $194.98 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Professional | 53 | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $1,148.15
| Facility | | $851.14 | $851.14 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $257.04 / $478.63
| Professional | | $194.98 | $257.04 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $169.82 / $269.15
| Facility | | $26.92 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $218.78 / $724.44
| Professional | | $40.74 | $218.78 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $489.78 / $812.83
| Facility | | $457.09 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $363.08
| Professional | | $204.17 | $302.00 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $316.23 / $331.13
| Professional | | $263.03 | $316.23 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $134.90 / $144.54
| Professional | 53 | $77.62 | $134.90 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $954.99 / $2,630.27
| Facility | | $331.13 | $954.99 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $323.59 / $575.44
| Professional | | $181.97 | $323.59 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $501.19
| Professional | 53 | $204.17 | $281.84 | $501.19 |