- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $5,248.07 / $8,912.51
| Facility | | $2,089.30 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $1,659.59
| Professional | | $575.44 | $758.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $7,585.78 / $13,803.84
| Facility | | $1,698.24 | $7,585.78 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $660.69 / $4,466.84
| Professional | | $616.60 | $660.69 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $776.25 / $1,513.56
| Professional | | $630.96 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $4,466.84 / $8,128.31
| Facility | | $707.95 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $4,073.80
| Facility | 53 | $354.81 | $354.81 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $14,125.38
| Facility | 54 | $1,230.27 | $1,230.27 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $3,019.95
| Facility | 55 | $263.03 | $263.03 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $776.25 / $5,128.61
| Professional | | $630.96 | $776.25 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $5,370.32 / $8,709.64
| Facility | | $3,981.07 | $5,370.32 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $707.95 / $1,230.27
| Professional | | $588.84 | $707.95 | $1,230.27 |