- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $6,456.54 / $10,471.29
| Facility | | $2,041.74 | $6,456.54 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $616.60 / $2,454.71
| Professional | | $218.78 | $616.60 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $177.83
| Professional | 53 | $114.82 | $114.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $407.38 / $2,187.76
| Professional | | $251.19 | $407.38 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $7,244.36 / $14,791.08
| Facility | | $5,754.40 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,071.52 / $2,454.71
| Professional | | $257.04 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,202.26 / $3,715.35
| Professional | | $426.58 | $1,202.26 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $2,398.83 / $6,456.54
| Facility | | $354.81 | $2,398.83 | $6,456.54 |
- 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
- $524.81 / $2,089.30 / $9,772.37
| Professional | | $524.81 | $2,089.30 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,691.53 / $3,890.45
| Professional | | $446.68 | $2,691.53 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $2,754.23
| Professional | | $501.19 | $501.19 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,079.46 / $7,079.46
| Facility | | $6,025.60 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $478.63 / $3,801.89
| Professional | | $3.98 | $478.63 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,897.79 / $6,760.83
| Facility | | $3,630.78 | $4,897.79 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $602.56 / $3,090.30
| Professional | | $309.03 | $602.56 | $3,090.30 |