- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $7,079.46
| Facility | | $660.69 | $660.69 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $794.33 / $1,445.44
| Professional | | $446.68 | $794.33 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $9,549.93 / $20,892.96
| Facility | | $5,248.07 | $9,549.93 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,445.44 / $2,238.72
| Professional | | $1,047.13 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $208.93 / $288.40 / $457.09
| Professional | 55 | $208.93 | $288.40 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,344.23 / $5,495.41
| Facility | | $1,659.59 | $2,344.23 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,778.28 / $2,818.38
| Professional | | $1,122.02 | $1,778.28 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,187.76 / $4,365.16
| Facility | | $1,778.28 | $2,187.76 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,548.82 / $2,511.89
| Professional | | $1,071.52 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,288.25 / $9,772.37
| Facility | | $741.31 | $1,288.25 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,584.89 / $3,981.07
| Professional | | $933.25 | $1,584.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $8,709.64 / $11,748.98
| Facility | | $1,584.89 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,513.56 / $2,951.21
| Professional | | $912.01 | $1,513.56 | $2,951.21 |