- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $3,162.28 / $7,943.28
| Facility | | $245.47 | $3,162.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $2,884.03 / $4,073.80 / $4,073.80
| Facility | 53 | $2,884.03 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $295.12 / $1,905.46
| Professional | | $147.91 | $295.12 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $9,549.93
| Facility | | $2,630.27 | $4,786.30 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $954.99 / $2,454.71
| Professional | | $758.58 | $954.99 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $3,801.89
| Facility | | $218.78 | $218.78 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $1,318.26
| Professional | | $218.78 | $218.78 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $4,365.16 / $53,703.18
| Facility | | $34.67 | $4,365.16 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $758.58 / $3,019.95
| Professional | | $177.83 | $758.58 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $165.96 / $467.74
| Facility | | $112.20 | $165.96 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,148.15 / $1,659.59
| Professional | | $851.14 | $1,148.15 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,122.02 / $2,089.30
| Professional | | $758.58 | $1,122.02 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,162.28 / $5,248.07
| Facility | | $2,089.30 | $3,162.28 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Professional | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $50,118.72 / $75,857.76
| Facility | | $169.82 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,348.96 / $2,187.76
| Professional | | $1,148.15 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,467.37 / $7,244.36
| Facility | | $1,862.09 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $851.14 / $2,187.76
| Professional | | $134.90 | $851.14 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $208.93
| Facility | | $120.23 | $162.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $912.01 / $1,659.59
| Professional | | $218.78 | $912.01 | $1,659.59 |