- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,995.26 / $3,019.95
| Facility | | $602.56 | $1,995.26 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $288.40
| Facility | 53 | $87.10 | $87.10 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $331.13 / $707.95
| Professional | | $173.78 | $331.13 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $60.26 / $128.82 / $269.15
| Professional | 53 | $60.26 | $128.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $630.96
| Professional | | $208.93 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $165.96 / $309.03
| Professional | 53 | $91.20 | $165.96 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $457.09 / $954.99
| Professional | | $204.17 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $257.04
| Professional | 53 | $131.83 | $131.83 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $309.03
| Facility | | $173.78 | $173.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $288.40
| Facility | 53 | $87.10 | $87.10 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $331.13 / $707.95
| Professional | | $173.78 | $331.13 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $72.44 / $151.36 / $338.84
| Professional | 53 | $72.44 | $151.36 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $398.11 / $794.33
| Professional | | $204.17 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $125.89 / $245.47 / $346.74
| Professional | 53 | $125.89 | $245.47 | $346.74 |