- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $3,388.44 / $8,709.64
| Facility | | $398.11 | $3,388.44 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $107.15 / $199.53 / $288.40
| Facility | 53 | $107.15 | $199.53 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $354.81 / $912.01
| Professional | | $177.83 | $354.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $263.03
| Professional | 53 | $83.18 | $141.25 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $173.78 / $436.52
| Professional | | $144.54 | $173.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $38.02 / $75.86 / $114.82
| Professional | 53 | $38.02 | $75.86 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,380.38 / $2,398.83
| Facility | | $588.84 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $407.38 / $741.31
| Professional | | $169.82 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $123.03 / $213.80
| Professional | 53 | $83.18 | $123.03 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $549.54 / $645.65
| Facility | | $371.54 | $549.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $676.08
| Professional | | $218.78 | $380.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $562.34 / $602.56
| Professional | | $524.81 | $562.34 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $194.98
| Professional | 53 | $120.23 | $181.97 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $380.19 / $676.08
| Facility | | $204.17 | $380.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $4,570.88 / $8,912.51
| Facility | | $691.83 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $316.23 / $602.56
| Professional | | $173.78 | $316.23 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $251.19
| Professional | 53 | $120.23 | $120.23 | $251.19 |