- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,677.35 / $8,128.31
| Facility | | $2,041.74 | $4,677.35 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $776.25 / $2,691.53
| Professional | | $346.74 | $776.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $724.44 / $2,137.96 / $4,365.16
| Professional | 50 | $724.44 | $2,137.96 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $234.42 / $524.81 / $1,047.13
| Professional | 54 | $234.42 | $524.81 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $6.76 / $48.98 / $100.00
| Professional | 55 | $6.76 | $48.98 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $489.78
| Professional | | $302.00 | $436.52 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $5,011.87 / $9,549.93
| Facility | | $1,174.90 | $5,011.87 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $562.34 / $2,398.83
| Professional | | $457.09 | $562.34 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,412.54 / $1,412.54
| Facility | | $1,000.00 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $660.69 / $1,380.38
| Professional | | $524.81 | $660.69 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,995.26 / $5,128.61
| Facility | | $562.34 | $1,995.26 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $1,318.26
| Facility | 53 | $281.84 | $281.84 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $4,570.88
| Facility | 54 | $977.24 | $977.24 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $977.24
| Facility | 55 | $208.93 | $208.93 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $707.95 / $6,025.60
| Professional | | $524.81 | $707.95 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Professional | 54 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,884.03 / $5,370.32
| Facility | | $1,949.84 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $630.96 / $1,047.13
| Professional | | $501.19 | $630.96 | $1,047.13 |