- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $5,495.41 / $8,709.64
| Facility | | $1,737.80 | $5,495.41 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $831.76 / $1,479.11
| Professional | | $691.83 | $831.76 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $1,348.96
| Professional | 54 | $524.81 | $524.81 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $223.87
| Professional | 55 | $69.18 | $69.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $933.25
| Professional | | $467.74 | $467.74 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,511.89 / $3,467.37
| Facility | | $1,659.59 | $2,511.89 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Professional | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $1,513.56
| Professional | | $794.33 | $1,071.52 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,584.89 / $26,302.68
| Facility | | $891.25 | $1,584.89 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,047.13 / $6,918.31
| Professional | | $741.31 | $1,047.13 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,041.74 / $4,677.35
| Facility | | $1,513.56 | $2,041.74 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,000.00 / $1,348.96
| Professional | | $724.44 | $1,000.00 | $1,348.96 |