- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $3,311.31 / $7,079.46
| Facility | | $1,288.25 | $3,311.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,071.52 / $4,168.69
| Professional | | $707.95 | $1,071.52 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $5,128.61
| Professional | 54 | $724.44 | $724.44 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $1,023.29
| Professional | 55 | $158.49 | $158.49 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $4,570.88 / $7,079.46
| Facility | | $3,019.95 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,445.44 / $3,630.78
| Professional | | $776.25 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Facility | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Professional | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,290.87 / $3,630.78
| Facility | | $1,949.84 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,398.83 / $2,951.21
| Professional | | $1,071.52 | $2,398.83 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $5,888.44 / $10,471.29
| Facility | | $812.83 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,862.09 / $2,187.76
| Professional | | $1,380.38 | $1,862.09 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,096.48 / $1,479.11 / $1,737.80
| Professional | 54 | $1,096.48 | $1,479.11 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $275.42 / $371.54 / $436.52
| Professional | 55 | $275.42 | $371.54 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $3,388.44 / $7,943.28
| Facility | | $812.83 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,584.89 / $6,918.31
| Professional | | $851.14 | $1,584.89 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $85.11
| Professional | | $32.36 | $33.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $5,754.40 / $7,762.47
| Facility | | $1,621.81 | $5,754.40 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $2,344.23 / $3,890.45
| Professional | | $912.01 | $2,344.23 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,479.11 / $2,290.87
| Professional | | $691.83 | $1,479.11 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,918.31 / $6,918.31
| Facility | | $4,677.35 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $3,235.94 / $4,786.30 / $4,786.30
| Facility | 54 | $3,235.94 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $707.95 / $1,023.29 / $1,023.29
| Facility | 55 | $707.95 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $4,786.30 / $6,918.31
| Professional | | $1,348.96 | $4,786.30 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,467.37
| Professional | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $7,244.36 / $7,244.36
| Professional | | $3,630.78 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $6,760.83 / $9,120.11
| Facility | | $3,162.28 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $1,479.11 / $5,495.41
| Professional | | $93.33 | $1,479.11 | $5,495.41 |