- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $5,248.07 / $9,332.54
| Facility | | $1,513.56 | $5,248.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $501.19 / $2,344.23
| Professional | | $223.87 | $501.19 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $144.54 / $1,071.52
| Professional | 53 | $77.62 | $144.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $1,230.27
| Professional | | $204.17 | $239.88 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Professional | 53 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Facility | | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $1,995.26
| Professional | | $204.17 | $346.74 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $407.38 / $1,905.46
| Professional | | $234.42 | $407.38 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $4,570.88 / $9,332.54
| Facility | | $977.24 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $512.86 / $2,041.74
| Professional | | $257.04 | $512.86 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $144.54 / $1,071.52
| Professional | 53 | $77.62 | $144.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $371.54 / $1,905.46
| Professional | | $213.80 | $371.54 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,897.79 / $8,912.51
| Facility | | $2,570.40 | $4,897.79 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $1,698.24
| Professional | | $281.84 | $389.05 | $1,698.24 |