- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $5,370.32 / $12,022.64
| Facility | | $1,122.02 | $5,370.32 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $933.25 / $2,511.89
| Professional | | $645.65 | $933.25 | $2,511.89 |
- 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
- $158.49 / $158.49 / $158.49
| Professional | 55 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $9,549.93
| Facility | | $2,630.27 | $4,786.30 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $912.01 / $2,089.30
| Professional | | $707.95 | $912.01 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $3,388.44 / $13,803.84
| Facility | | $1,047.13 | $3,388.44 | $13,803.84 |
- 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
- $1,230.27 / $4,168.69 / $53,703.18
| Facility | | $1,230.27 | $4,168.69 | $53,703.18 |
- 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
- $616.60 / $1,122.02 / $3,467.37
| Professional | | $616.60 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $2,398.83
| Facility | | $724.44 | $1,023.29 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $870.96 / $1,202.26
| Professional | | $660.69 | $870.96 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $933.25 / $1,548.82
| Professional | | $549.54 | $933.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $467.74 / $758.58 / $1,258.93
| Professional | 54 | $467.74 | $758.58 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $117.49 / $190.55 / $316.23
| Professional | 55 | $117.49 | $190.55 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $6,165.95 / $8,317.64
| Facility | | $4,570.88 | $6,165.95 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $912.01 / $954.99
| Professional | | $758.58 | $912.01 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $660.69 / $676.08 / $676.08
| Professional | 54 | $660.69 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $50,118.72 / $75,857.76
| Facility | | $1,000.00 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $912.01 / $1,513.56
| Professional | | $398.11 | $912.01 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,981.07 / $8,709.64
| Facility | | $2,137.96 | $3,981.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $870.96 / $1,380.38
| Professional | | $691.83 | $870.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,000.00 / $3,090.30
| Facility | | $602.56 | $1,000.00 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $478.63 / $501.19 / $812.83
| Facility | 54 | $478.63 | $501.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $199.53
| Facility | 55 | $120.23 | $141.25 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $933.25 / $3,019.95
| Professional | | $588.84 | $933.25 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $467.74 / $660.69 / $1,258.93
| Professional | 54 | $467.74 | $660.69 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $120.23 / $190.55 / $371.54
| Professional | 55 | $120.23 | $190.55 | $371.54 |