- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $2,691.53 / $6,760.83
| Facility | | $912.01 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $316.23 / $616.60 / $1,071.52
| Facility | 53 | $316.23 | $616.60 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $338.84 / $776.25
| Professional | | $181.97 | $338.84 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $295.12
| Professional | 53 | $83.18 | $162.18 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $741.31
| Professional | | $199.53 | $363.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $549.54 / $3,162.28
| Facility | | $229.09 | $549.54 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $281.84 / $562.34 / $1,071.52
| Facility | 53 | $281.84 | $562.34 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $812.83 / $1,905.46
| Professional | | $323.59 | $812.83 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $204.17 / $645.65
| Professional | 53 | $91.20 | $204.17 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,202.26 / $1,819.70
| Professional | | $741.31 | $1,202.26 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $416.87 / $891.25
| Facility | | $213.80 | $416.87 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $436.52 / $933.25
| Professional | | $190.55 | $436.52 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $371.54 / $1,230.27
| Professional | | $173.78 | $371.54 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $346.74
| Professional | 53 | $288.40 | $288.40 | $346.74 |