- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,570.40 / $21,877.62
| Facility | | $794.33 | $2,570.40 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $1,819.70
| Professional | | $707.95 | $870.96 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $588.84 / $1,047.13 / $1,071.52
| Professional | 54 | $588.84 | $1,047.13 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $158.49
| Professional | 55 | $44.67 | $44.67 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,011.87 / $10,471.29
| Facility | | $3,019.95 | $5,011.87 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,370.32 / $8,709.64 / $24,547.09
| Facility | 50 | $5,370.32 | $8,709.64 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,584.89 / $2,630.27
| Professional | | $1,096.48 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $870.96 / $1,258.93 / $2,137.96
| Professional | 54 | $870.96 | $1,258.93 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $537.03
| Professional | 55 | $218.78 | $316.23 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,754.23 / $6,606.93
| Facility | | $1,949.84 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,089.30 / $3,467.37
| Professional | | $1,318.26 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,630.27 / $5,128.61
| Facility | | $2,137.96 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,862.09 / $2,951.21
| Professional | | $1,258.93 | $1,862.09 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,479.11 / $5,623.41
| Facility | | $954.99 | $1,479.11 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,445.44 / $4,168.69
| Professional | | $758.58 | $1,445.44 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,023.29 / $1,047.13 / $1,096.48
| Professional | 54 | $1,023.29 | $1,047.13 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | 55 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,248.07 / $8,912.51
| Facility | | $3,019.95 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,412.54 / $3,019.95
| Professional | | $851.14 | $1,412.54 | $3,019.95 |