- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,897.79 / $8,511.38
| Facility | | $1,737.80 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | 50 | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $933.25 / $1,995.26
| Professional | | $691.83 | $933.25 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $524.81 / $794.33 / $1,348.96
| Professional | 54 | $524.81 | $794.33 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $69.18 / $169.82 / $223.87
| Professional | 55 | $69.18 | $169.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,786.30 / $8,912.51
| Facility | | $2,238.72 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,122.02 / $1,548.82
| Professional | | $831.76 | $1,122.02 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $676.08 / $1,148.15
| Professional | | $630.96 | $676.08 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $7,762.47 / $10,232.93
| Facility | | $4,365.16 | $7,762.47 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,047.13 / $1,905.46
| Professional | | $295.12 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $2,398.83 / $26,302.68
| Facility | | $831.76 | $2,398.83 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,348.96 / $4,570.88 / $4,570.88
| Facility | 54 | $1,348.96 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $288.40 / $977.24 / $977.24
| Facility | 55 | $288.40 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $6,918.31
| Professional | | $724.44 | $1,071.52 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Professional | 54 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,398.83 / $4,677.35
| Facility | | $1,819.70 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $954.99 / $1,445.44
| Professional | | $691.83 | $954.99 | $1,445.44 |