- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $5,623.41 / $9,549.93
| Facility | | $4,168.69 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $954.99 / $1,584.89
| Professional | | $630.96 | $954.99 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $630.96 / $1,071.52
| Professional | | $562.34 | $630.96 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,073.80 / $10,000.00
| Facility | | $1,412.54 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,348.96 / $1,621.81
| Professional | | $870.96 | $1,348.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,290.87 / $2,884.03
| Facility | | $776.25 | $2,290.87 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,380.38 / $2,089.30
| Professional | | $602.56 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $776.25 / $2,398.83
| Professional | | $602.56 | $776.25 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $1,148.15
| Professional | 54 | $741.31 | $741.31 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $81.28
| Professional | 55 | $52.48 | $52.48 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $66.07
| Professional | 80 | $42.66 | $42.66 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $9,332.54 / $12,882.50
| Facility | | $6,025.60 | $9,332.54 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,659.59 / $3,715.35
| Professional | | $794.33 | $1,659.59 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $6,165.95 / $10,715.19
| Facility | | $1,513.56 | $6,165.95 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,258.93 / $1,819.70
| Professional | | $851.14 | $1,258.93 | $1,819.70 |