- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $4,168.69 / $7,413.10
| Facility | | $977.24 | $4,168.69 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,128.61 / $5,248.07 / $12,589.25
| Facility | 50 | $5,128.61 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $588.84 / $1,202.26
| Professional | | $512.86 | $588.84 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $870.96
| Professional | 54 | $83.18 | $83.18 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $9.77 / $93.33 / $95.50
| Professional | 55 | $9.77 | $93.33 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $870.96 / $1,096.48
| Professional | | $501.19 | $870.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,174.90
| Professional | | $32.36 | $33.11 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,466.84 / $6,760.83
| Facility | | $3,235.94 | $4,466.84 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,897.79 / $6,760.83 / $10,232.93
| Facility | 50 | $4,897.79 | $6,760.83 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $831.76 / $4,265.80
| Professional | | $707.95 | $831.76 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $831.76 / $1,445.44
| Professional | | $489.78 | $831.76 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $812.83 / $1,659.59
| Professional | | $588.84 | $812.83 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $4,168.69 / $6,918.31
| Facility | | $1,995.26 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $691.83 / $1,148.15
| Professional | | $501.19 | $691.83 | $1,148.15 |