- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $2,570.40 / $6,025.60
| Facility | | $316.23 | $2,570.40 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $389.05
| Facility | 53 | $120.23 | $173.78 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $309.03 / $954.99
| Professional | | $173.78 | $309.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $338.84
| Professional | 53 | $64.57 | $128.82 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $2,290.87
| Facility | | $851.14 | $851.14 | $2,290.87 |
- 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
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $912.01
| Professional | | $316.23 | $478.63 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $912.01
| Professional | 53 | $316.23 | $478.63 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $398.11 / $831.76
| Facility | | $181.97 | $398.11 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $389.05
| Facility | 53 | $120.23 | $177.83 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $489.78 / $831.76
| Professional | | $288.40 | $489.78 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $338.84
| Professional | 53 | $74.13 | $147.91 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $676.08
| Facility | | $331.13 | $588.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $416.87 / $794.33
| Professional | | $275.42 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $363.08 / $724.44
| Facility | | $173.78 | $363.08 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $467.74 / $870.96
| Professional | | $302.00 | $467.74 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,019.95 / $3,715.35
| Facility | | $2,137.96 | $3,019.95 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 53 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $549.54 / $891.25
| Professional | | $346.74 | $549.54 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $169.82 / $257.04 / $446.68
| Professional | 53 | $169.82 | $257.04 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $2,818.38 / $4,897.79
| Facility | | $1,096.48 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $489.78 / $851.14
| Professional | | $281.84 | $489.78 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $204.17
| Professional | 53 | $134.90 | $134.90 | $204.17 |