- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,162.28 / $9,332.54
| Facility | | $1,000.00 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $891.25 / $1,995.26
| Professional | | $630.96 | $891.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $891.25 / $1,862.09
| Professional | | $707.95 | $891.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,258.93 / $4,073.80
| Facility | | $1,148.15 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,884.03 / $53,703.18
| Facility | | $1,348.96 | $2,884.03 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Facility | 54 | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,071.52 / $3,235.94
| Professional | | $616.60 | $1,071.52 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $912.01 / $2,630.27
| Facility | | $645.65 | $912.01 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,000.00 / $1,513.56
| Professional | | $812.83 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $977.24 / $1,737.80
| Professional | | $562.34 | $977.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $346.74
| Professional | 55 | $123.03 | $208.93 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $933.25 / $1,000.00
| Professional | | $758.58 | $933.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $50,118.72 / $75,857.76
| Facility | | $707.95 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $954.99 / $1,659.59
| Professional | | $398.11 | $954.99 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,981.07 / $9,332.54
| Facility | | $2,137.96 | $3,981.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $954.99 / $2,290.87
| Professional | | $645.65 | $954.99 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,122.02 / $2,238.72
| Facility | | $660.69 | $1,122.02 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $457.09 / $537.03 / $891.25
| Facility | 54 | $457.09 | $537.03 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $977.24 / $2,754.23
| Professional | | $616.60 | $977.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $128.82 / $194.98 / $407.38
| Professional | 55 | $128.82 | $194.98 | $407.38 |