- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $5,495.41 / $12,022.64
| Facility | | $1,230.27 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,011.87 / $10,964.78 / $26,915.35
| Facility | 50 | $5,011.87 | $10,964.78 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $2,570.40
| Professional | | $691.83 | $977.24 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $1,348.96
| Professional | 54 | $524.81 | $724.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $44.67 / $169.82 / $229.09
| Professional | 55 | $44.67 | $169.82 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $8,511.38 / $19,054.61
| Facility | | $2,818.38 | $8,511.38 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,096.48 / $2,089.30
| Professional | | $741.31 | $1,096.48 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $1,995.26
| Professional | 54 | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $257.04
| Professional | 55 | $169.82 | $169.82 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,290.87 / $6,606.93
| Facility | | $1,122.02 | $2,290.87 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | 22 | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | 54 | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | 55 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,174.90 / $2,454.71
| Professional | | $691.83 | $1,174.90 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,981.07 / $9,120.11
| Facility | | $1,584.89 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $891.25 / $1,778.28
| Professional | | $645.65 | $891.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Professional | 55 | $199.53 | $199.53 | $199.53 |