- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $3,715.35 / $6,918.31
| Facility | | $1,949.84 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,122.02 / $2,290.87
| Professional | | $707.95 | $1,122.02 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $524.81 / $602.56 / $1,348.96
| Professional | 54 | $524.81 | $602.56 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | 55 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $4,265.80 / $11,220.18
| Facility | | $1,698.24 | $4,265.80 | $11,220.18 |
- 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
- $660.69 / $1,148.15 / $6,918.31
| Professional | | $660.69 | $1,148.15 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,445.44 / $1,995.26
| Professional | | $870.96 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $616.60 / $1,023.29 / $1,380.38
| Professional | 54 | $616.60 | $1,023.29 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $173.78 / $295.12 / $398.11
| Professional | 55 | $173.78 | $295.12 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,318.26 / $2,570.40
| Professional | | $691.83 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $933.25 / $5,248.07
| Facility | | $660.69 | $933.25 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $831.76 / $1,071.52
| Professional | | $707.95 | $831.76 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,265.80 / $9,772.37
| Facility | | $2,041.74 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,148.15 / $2,041.74
| Professional | | $645.65 | $1,148.15 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,258.93 / $8,317.64
| Facility | | $1,230.27 | $1,258.93 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,071.52 / $1,380.38
| Professional | | $912.01 | $1,071.52 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $4,265.80 / $11,220.18
| Facility | | $1,698.24 | $4,265.80 | $11,220.18 |
- 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
- $660.69 / $1,148.15 / $6,918.31
| Professional | | $660.69 | $1,148.15 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $912.01 / $1,380.38
| Professional | | $758.58 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,890.45 / $8,709.64
| Facility | | $1,698.24 | $3,890.45 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,258.93 / $2,398.83
| Professional | | $758.58 | $1,258.93 | $2,398.83 |