- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $4,897.79 / $9,549.93
| Facility | | $4.90 | $4,897.79 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $776.25 / $1,659.59
| Professional | | $630.96 | $776.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,570.88 / $7,762.47
| Facility | | $2,570.40 | $4,570.88 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $524.81 / $794.33
| Professional | | $446.68 | $524.81 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $758.58 / $977.24
| Facility | | $616.60 | $758.58 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $851.14 / $1,023.29
| Professional | | $676.08 | $851.14 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $1,122.02 / $1,122.02
| Facility | | $34.67 | $1,122.02 | $1,122.02 |
- 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
- $660.69 / $1,071.52 / $3,162.28
| Professional | | $660.69 | $1,071.52 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $407.38
| Professional | | $32.36 | $33.11 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $6,025.60 / $10,471.29
| Facility | | $851.14 | $6,025.60 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $794.33 / $1,380.38
| Professional | | $616.60 | $794.33 | $1,380.38 |