- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $6,309.57 / $11,220.18
| Facility | | $1,148.15 | $6,309.57 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $724.44 / $1,288.25
| Professional | | $501.19 | $724.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,122.02 / $2,951.21
| Professional | | $537.03 | $1,122.02 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $5,495.41 / $11,220.18
| Facility | | $1,174.90 | $5,495.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $588.84 / $630.96
| Professional | | $467.74 | $588.84 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,715.35 / $4,073.80
| Facility | | $707.95 | $3,715.35 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 22 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | 53 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 54 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | 55 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $831.76 / $1,584.89
| Professional | | $501.19 | $831.76 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $13,489.63 / $23,442.29
| Facility | | $6,165.95 | $13,489.63 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $436.52 / $707.95
| Professional | | $316.23 | $436.52 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $9,332.54 / $15,848.93
| Facility | | $3,311.31 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $1,202.26
| Professional | | $524.81 | $724.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $575.44 / $676.08
| Professional | | $562.34 | $575.44 | $676.08 |