- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $5,370.32 / $11,481.54
| Facility | | $2,290.87 | $5,370.32 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $954.99 / $2,041.74
| Professional | | $691.83 | $954.99 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $537.03 / $602.56 / $1,023.29
| Professional | 54 | $537.03 | $602.56 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $69.18 / $169.82 / $229.09
| Professional | 55 | $69.18 | $169.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $977.24 / $1,318.26
| Professional | | $660.69 | $977.24 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,467.37 / $5,888.44
| Facility | | $1,174.90 | $3,467.37 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,174.90 / $1,698.24
| Professional | | $831.76 | $1,174.90 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $257.04
| Professional | 55 | $169.82 | $169.82 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $891.25 / $1,047.13
| Facility | | $691.83 | $891.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $977.24
| Professional | | $933.25 | $933.25 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,548.82 / $1,659.59
| Facility | | $1,230.27 | $1,548.82 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,288.25 / $2,041.74
| Professional | | $724.44 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,023.29 / $2,754.23
| Professional | | $707.95 | $1,023.29 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $2,951.21
| Professional | 22 | $1,905.46 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $1,380.38
| Professional | 54 | $891.25 | $891.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $97.72
| Professional | 55 | $63.10 | $63.10 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,570.88 / $5,495.41
| Facility | | $3,235.94 | $4,570.88 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,071.52 / $1,819.70
| Professional | | $870.96 | $1,071.52 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,548.13 / $6,165.95
| Facility | | $1,174.90 | $3,548.13 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,096.48 / $1,778.28
| Professional | | $724.44 | $1,096.48 | $1,778.28 |