- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $6,760.83 / $9,772.37
| Facility | | $4,365.16 | $6,760.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $741.31 / $2,187.76
| Professional | | $407.38 | $741.31 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,187.76
| Professional | 50 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $398.11 / $537.03 / $1,047.13
| Professional | 54 | $398.11 | $537.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $6.76 / $48.98 / $107.15
| Professional | 55 | $6.76 | $48.98 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,168.69 / $12,022.64
| Facility | | $3,548.13 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,096.48 / $1,548.82
| Professional | | $588.84 | $1,096.48 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $870.96 / $1,621.81 / $2,344.23
| Professional | 50 | $870.96 | $1,621.81 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,000.00 / $1,995.26
| Professional | | $537.03 | $1,000.00 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $707.95 / $1,148.15
| Professional | | $478.63 | $707.95 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $4,466.84
| Facility | | $1,513.56 | $1,513.56 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $758.58 / $1,698.24
| Professional | | $616.60 | $758.58 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $7,585.78 / $11,220.18
| Facility | | $4,897.79 | $7,585.78 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $676.08 / $1,288.25
| Professional | | $478.63 | $676.08 | $1,288.25 |