- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $8,511.38 / $19,952.62
| Facility | | $3,801.89 | $8,511.38 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $954.99 / $3,467.37
| Professional | | $741.31 | $954.99 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $316.23 / $724.44 / $1,071.52
| Professional | 54 | $316.23 | $724.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $69.18 / $169.82 / $229.09
| Professional | 55 | $69.18 | $169.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $724.44 / $1,445.44
| Professional | | $467.74 | $724.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $13,489.63 / $22,387.21
| Facility | | $7,762.47 | $13,489.63 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,380.38 / $2,818.38
| Professional | | $1,023.29 | $1,380.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $9,120.11 / $19,952.62
| Facility | | $85.11 | $9,120.11 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,288.25 / $2,818.38
| Professional | | $933.25 | $1,288.25 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,737.80 / $2,344.23
| Facility | | $1,071.52 | $1,737.80 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,122.02 / $2,089.30
| Professional | | $794.33 | $1,122.02 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,000.00 / $1,737.80
| Professional | | $758.58 | $1,000.00 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $776.25 / $1,548.82
| Professional | | $588.84 | $776.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Professional | 50 | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $33,884.42 / $33,884.42
| Facility | | $7,079.46 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | 54 | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | 55 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $6,918.31
| Professional | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,096.48 / $1,737.80
| Facility | | $758.58 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,122.02 / $2,137.96
| Professional | | $794.33 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Professional | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,412.54 / $2,187.76
| Professional | | $676.08 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $7,079.46 / $14,454.40
| Facility | | $3,715.35 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $870.96 / $1,862.09
| Professional | | $616.60 | $870.96 | $1,862.09 |