- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $5,370.32 / $9,772.37
| Facility | | $1,023.29 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $616.60 / $1,096.48
| Professional | | $100.00 | $616.60 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $389.05 / $407.38 / $1,047.13
| Professional | 54 | $389.05 | $407.38 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $7.76 / $97.72 / $141.25
| Professional | 55 | $7.76 | $97.72 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $933.25 / $933.25
| Professional | | $316.23 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,691.53 / $4,073.80
| Facility | | $2,290.87 | $2,691.53 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $812.83 / $1,230.27
| Professional | | $602.56 | $812.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,479.11 / $26,302.68
| Facility | | $645.65 | $1,479.11 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $758.58 / $6,025.60
| Professional | | $537.03 | $758.58 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | 54 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,041.74 / $4,677.35
| Facility | | $1,513.56 | $2,041.74 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $954.99
| Professional | | $524.81 | $724.44 | $954.99 |