- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $7,943.28 / $13,182.57
| Facility | | $524.81 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $512.86 / $2,398.83
| Professional | | $251.19 | $512.86 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $281.84 / $1,584.89
| Professional | 53 | $77.62 | $281.84 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $676.08 / $3,630.78
| Professional | | $331.13 | $676.08 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,258.93 / $3,162.28
| Professional | | $380.19 | $1,258.93 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,819.70 / $11,220.18
| Facility | | $295.12 | $1,819.70 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $602.56 / $2,951.21
| Professional | | $338.84 | $602.56 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $1,584.89
| Professional | 53 | $77.62 | $77.62 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $2,454.71 / $2,630.27
| Facility | | $537.03 | $2,454.71 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $588.84 / $2,691.53
| Facility | | $269.15 | $588.84 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $602.56 / $3,388.44
| Professional | | $79.43 | $602.56 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $9,772.37 / $12,302.69
| Facility | | $7,079.46 | $9,772.37 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $724.44 / $3,630.78
| Professional | | $467.74 | $724.44 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $9,772.37 / $14,125.38
| Facility | | $2,951.21 | $9,772.37 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $676.08 / $3,467.37
| Professional | | $346.74 | $676.08 | $3,467.37 |