- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $5,495.41 / $6,760.83
| Facility | | $1,737.80 | $5,495.41 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $977.24 / $2,137.96
| Professional | | $602.56 | $977.24 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,677.35 / $13,489.63
| Facility | | $1,737.80 | $4,677.35 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,288.25 / $1,412.54
| Professional | | $1,096.48 | $1,288.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $104.71 / $128.82 / $134.90
| Professional | 55 | $104.71 | $128.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $954.99 / $1,230.27
| Professional | | $537.03 | $954.99 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,479.11 / $5,495.41
| Facility | | $575.44 | $1,479.11 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,023.29 / $1,288.25
| Professional | | $588.84 | $1,023.29 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $11,748.98 / $16,595.87
| Facility | | $9,120.11 | $11,748.98 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,348.96 / $1,445.44
| Professional | | $1,122.02 | $1,348.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $616.60 / $12,589.25
| Professional | | $549.54 | $616.60 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $22,387.21 / $27,542.29
| Facility | | $1,995.26 | $22,387.21 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $977.24 / $1,318.26
| Professional | | $724.44 | $977.24 | $1,318.26 |