- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $4,570.88 / $7,943.28
| Facility | | $549.54 | $4,570.88 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $467.74 / $1,949.84
| Professional | | $223.87 | $467.74 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $177.83 / $281.84 / $1,584.89
| Professional | 53 | $177.83 | $281.84 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $3,715.35
| Professional | | $512.86 | $645.65 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,202.26 / $3,388.44
| Professional | | $229.09 | $1,202.26 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,511.89 / $8,128.31
| Facility | | $446.68 | $2,511.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | 52 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 53 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,548.82 / $4,897.79
| Professional | | $446.68 | $1,548.82 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,659.59 / $3,235.94
| Professional | | $537.03 | $1,659.59 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $741.31 / $3,890.45
| Professional | | $524.81 | $741.31 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $10,471.29 / $29,512.09
| Facility | | $3,162.28 | $10,471.29 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $794.33 / $3,801.89
| Professional | | $3.98 | $794.33 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $6,309.57 / $8,912.51
| Facility | | $4,073.80 | $6,309.57 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $660.69 / $3,019.95
| Professional | | $263.03 | $660.69 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $512.86 / $2,754.23
| Professional | | $436.52 | $512.86 | $2,754.23 |