- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $3,235.94 / $5,495.41
| Facility | | $257.04 | $3,235.94 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $257.04
| Facility | 53 | $85.11 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $776.25
| Professional | | $169.82 | $316.23 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $131.83 / $245.47
| Professional | 53 | $74.13 | $131.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $194.98 / $251.19
| Professional | | $162.18 | $194.98 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $81.28 / $87.10 / $123.03
| Professional | 53 | $81.28 | $87.10 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $4,466.84 / $8,317.64
| Facility | | $2,089.30 | $4,466.84 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $380.19 / $588.84
| Professional | | $213.80 | $380.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $79.43 / $177.83 / $354.81
| Professional | 53 | $79.43 | $177.83 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $144.54 / $239.88
| Facility | | $24.55 | $144.54 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $151.36 / $426.58
| Professional | | $41.69 | $151.36 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $302.00 / $758.58
| Facility | | $275.42 | $302.00 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $478.63
| Professional | | $302.00 | $302.00 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $93.33 / $151.36 / $275.42
| Professional | 53 | $93.33 | $151.36 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,715.35 / $4,466.84
| Facility | | $1,862.09 | $3,715.35 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $309.03 / $524.81
| Professional | | $177.83 | $309.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $79.43 / $134.90 / $204.17
| Professional | 53 | $79.43 | $134.90 | $204.17 |