- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $4,897.79 / $8,317.64
| Facility | | $1,148.15 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $812.83 / $1,659.59
| Professional | | $630.96 | $812.83 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $741.31 / $1,230.27
| Professional | | $602.56 | $741.31 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $616.60 / $1,047.13
| Professional | | $575.44 | $616.60 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $4,168.69
| Facility | | $588.84 | $588.84 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $912.01 / $1,819.70
| Professional | | $371.54 | $912.01 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $2,137.96 / $11,481.54
| Facility | | $54.95 | $2,137.96 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $354.81 / $4,073.80 / $4,073.80
| Facility | 53 | $354.81 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,230.27 / $14,125.38 / $14,125.38
| Facility | 54 | $1,230.27 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $263.03 / $3,019.95 / $3,019.95
| Facility | 55 | $263.03 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $912.01 / $5,128.61
| Professional | | $660.69 | $912.01 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,801.89 / $6,606.93
| Facility | | $2,454.71 | $3,801.89 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $831.76 / $1,258.93
| Professional | | $616.60 | $831.76 | $1,258.93 |