- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $2,290.87 / $7,762.47
| Facility | | $457.09 | $2,290.87 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $741.31 / $1,202.26 / $3,467.37
| Facility | 50 | $741.31 | $1,202.26 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Facility | 54 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $371.54 / $812.83
| Professional | | $281.84 | $371.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $724.44 / $1,819.70
| Professional | 50 | $407.38 | $724.44 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $239.88 / $354.81 / $676.08
| Professional | 54 | $239.88 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $389.05
| Professional | 55 | $53.70 | $63.10 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $4,365.16 / $10,000.00
| Facility | | $1,584.89 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $371.54 / $758.58
| Professional | | $257.04 | $371.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $537.03 / $1,071.52
| Professional | 50 | $380.19 | $537.03 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,174.90 / $2,511.89
| Facility | | $407.38 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Facility | 54 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | 55 | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $426.58 / $977.24
| Professional | | $269.15 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,698.24 / $4,365.16
| Facility | | $467.74 | $1,698.24 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $707.95
| Professional | | $229.09 | $338.84 | $707.95 |