- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,318.26 / $3,548.13
| Facility | | $616.60 | $1,318.26 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $60.26 / $104.71 / $117.49
| Facility | 53 | $60.26 | $104.71 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $281.84 / $630.96
| Professional | | $147.91 | $281.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $60.26 / $112.20 / $194.98
| Professional | 53 | $60.26 | $112.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $416.87
| Professional | | $162.18 | $223.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $144.54
| Professional | 53 | $117.49 | $117.49 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $575.44
| Facility | | $524.81 | $524.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Professional | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $467.74 / $1,148.15
| Facility | | $436.52 | $467.74 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $363.08
| Professional | | $302.00 | $302.00 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $467.74
| Professional | 53 | $125.89 | $125.89 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,000.00 / $1,862.09
| Facility | | $457.09 | $1,000.00 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $316.23 / $691.83
| Professional | | $173.78 | $316.23 | $691.83 |