- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $2,818.38 / $7,244.36
| Facility | | $234.42 | $2,818.38 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $173.78 / $281.84
| Facility | 53 | $91.20 | $173.78 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $218.78 / $3,467.37
| Facility | | $109.65 | $218.78 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,230.27 / $50,118.72
| Facility | | $263.03 | $1,230.27 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | 53 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $281.84 / $549.54
| Facility | | $165.96 | $281.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $75.86 / $125.89 / $309.03
| Facility | 53 | $75.86 | $125.89 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Facility | 53 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,348.96 / $2,691.53
| Facility | | $602.56 | $1,348.96 | $2,691.53 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,467.37 / $7,244.36
| Facility | | $1,584.89 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $186.21 / $660.69
| Facility | | $125.89 | $186.21 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $93.33
| Facility | 53 | $63.10 | $93.33 | $93.33 |