- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $5,248.07 / $9,120.11
| Facility | | $1,174.90 | $5,248.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,148.15 / $3,801.89
| Professional | | $512.86 | $1,148.15 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $1,995.26
| Professional | 50 | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $346.74 / $457.09 / $776.25
| Professional | 54 | $346.74 | $457.09 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $5.62 / $17.78 / $36.31
| Professional | 55 | $5.62 | $17.78 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,096.48 / $2,691.53
| Facility | | $537.03 | $1,096.48 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,071.52 / $1,148.15
| Professional | | $537.03 | $1,071.52 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,258.93 / $1,584.89
| Professional | | $1,122.02 | $1,258.93 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $794.33 / $2,691.53
| Facility | | $478.63 | $794.33 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $977.24 / $2,187.76
| Professional | | $512.86 | $977.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $1,513.56
| Professional | 54 | $831.76 | $831.76 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.14
| Professional | 55 | $2.14 | $2.14 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,479.11 / $1,479.11
| Professional | | $1,318.26 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,047.13 / $1,096.48
| Professional | | $724.44 | $1,047.13 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $4,677.35
| Facility | | $2,691.53 | $2,691.53 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,071.52 / $1,584.89
| Professional | | $660.69 | $1,071.52 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,230.27 / $1,230.27
| Professional | | $1,023.29 | $1,230.27 | $1,230.27 |