- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $6,606.93 / $11,748.98
| Facility | | $1,659.59 | $6,606.93 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $707.95 / $1,737.80
| Professional | | $489.78 | $707.95 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $281.84 / $588.84 / $851.14
| Professional | 54 | $281.84 | $588.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $407.38
| Professional | 55 | $95.50 | $190.55 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $446.68 / $478.63
| Professional | | $416.87 | $446.68 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,981.07 / $8,709.64
| Facility | | $1,659.59 | $3,981.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,023.29 / $1,548.82
| Professional | | $457.09 | $1,023.29 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,995.26
| Facility | | $1,122.02 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $851.14 / $1,380.38
| Professional | | $616.60 | $851.14 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $870.96 / $1,862.09
| Facility | | $537.03 | $870.96 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $10,000.00 / $16,595.87
| Facility | | $1,778.28 | $10,000.00 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $630.96 / $1,096.48
| Professional | | $457.09 | $630.96 | $1,096.48 |