- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $4,677.35 / $8,317.64
| Facility | | $1,819.70 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $446.68 / $1,778.28
| Professional | | $213.80 | $446.68 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $77.62
| Professional | 53 | $69.18 | $69.18 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $6,309.57 / $12,589.25
| Facility | | $2,818.38 | $6,309.57 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,513.56 / $4,365.16
| Professional | | $416.87 | $1,513.56 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $5,011.87 / $12,022.64
| Facility | | $3,467.37 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,137.96 / $5,370.32
| Professional | | $489.78 | $2,137.96 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,570.88 / $8,912.51
| Facility | | $3,630.78 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,905.46 / $4,897.79
| Professional | | $489.78 | $1,905.46 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $2,630.27 / $7,585.78
| Facility | | $501.19 | $2,630.27 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,090.30 / $7,585.78
| Professional | | $1,380.38 | $3,090.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,248.07 / $8,912.51
| Facility | | $3,019.95 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,230.27 / $4,570.88
| Professional | | $346.74 | $1,230.27 | $4,570.88 |