- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $5,495.41 / $10,000.00
| Facility | | $4,466.84 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $831.76 / $1,548.82
| Professional | | $478.63 | $831.76 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $870.96
| Professional | 54 | $398.11 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $8.91 / $47.86 / $100.00
| Professional | 55 | $8.91 | $47.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,445.44 / $1,778.28
| Professional | | $501.19 | $1,445.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $4,265.80 / $7,585.78
| Facility | | $602.56 | $4,265.80 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,258.93 / $2,398.83
| Professional | | $602.56 | $1,258.93 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $870.96
| Professional | 54 | $398.11 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $8.91 / $41.69 / $97.72
| Professional | 55 | $8.91 | $41.69 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $3,388.44
| Professional | | $2,187.76 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $691.83 / $4,265.80
| Facility | | $588.84 | $691.83 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $602.56 / $1,778.28
| Professional | | $60.26 | $602.56 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $977.24 / $4,365.16
| Professional | | $616.60 | $977.24 | $4,365.16 |