- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $2,570.40 / $5,623.41
| Facility | | $371.54 | $2,570.40 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $218.78
| Facility | 53 | $91.20 | $134.90 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $436.52
| Professional | | $154.88 | $263.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $72.44 / $120.23 / $199.53
| Professional | 53 | $72.44 | $120.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $223.87
| Professional | | $162.18 | $199.53 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $87.10
| Professional | 53 | $81.28 | $81.28 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,584.89 / $2,238.72
| Facility | | $1,148.15 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $331.13 / $446.68
| Professional | | $177.83 | $331.13 | $446.68 |
- 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
- 53
- Typical Low / Median / Typical High
- $147.91 / $229.09 / $251.19
| Professional | 53 | $147.91 | $229.09 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $1,479.11
| Facility | | $181.97 | $354.81 | $1,479.11 |
- 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
- $288.40 / $416.87 / $2,187.76
| Professional | | $288.40 | $416.87 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,318.26 / $2,511.89
| Facility | | $371.54 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $478.63
| Professional | | $173.78 | $288.40 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $125.89
| Professional | 53 | $60.26 | $60.26 | $125.89 |