- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $2,187.76 / $4,677.35
| Facility | | $346.74 | $2,187.76 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $75.86 / $194.98 / $389.05
| Facility | 53 | $75.86 | $194.98 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $363.08 / $1,412.54
| Professional | | $169.82 | $363.08 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $72.44 / $144.54 / $323.59
| Professional | 53 | $72.44 | $144.54 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $371.54 / $691.83
| Professional | | $194.98 | $371.54 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $134.90 / $229.09 / $436.52
| Professional | 53 | $134.90 | $229.09 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $616.60 / $1,071.52
| Professional | | $165.96 | $616.60 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $467.74 / $2,137.96
| Facility | | $213.80 | $467.74 | $2,137.96 |
- 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
- $338.84 / $616.60 / $2,187.76
| Professional | | $338.84 | $616.60 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $489.78 / $912.01
| Professional | | $295.12 | $489.78 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $147.91 / $245.47 / $436.52
| Professional | 53 | $147.91 | $245.47 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $616.60 / $933.25
| Professional | | $407.38 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $100.00 / $245.47 / $467.74
| Professional | 53 | $100.00 | $245.47 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $870.96 / $2,454.71
| Facility | | $457.09 | $870.96 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $316.23 / $741.31
| Professional | | $100.00 | $316.23 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,995.26 / $3,890.45
| Facility | | $1,174.90 | $1,995.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $776.25
| Professional | | $208.93 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $204.17
| Professional | 53 | $112.20 | $173.78 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $426.58 / $758.58
| Professional | | $354.81 | $426.58 | $758.58 |