- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $6,025.60 / $10,964.78
| Facility | | $2,290.87 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,884.03 / $4,365.16 / $4,365.16
| Facility | 50 | $2,884.03 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $724.44 / $2,454.71
| Professional | | $407.38 | $724.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $1,778.28 / $2,187.76
| Professional | 50 | $776.25 | $1,778.28 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $363.08 / $457.09 / $1,096.48
| Professional | 54 | $363.08 | $457.09 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $28.18 / $107.15 / $870.96
| Professional | 55 | $28.18 | $107.15 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $691.83 / $1,380.38
| Professional | | $426.58 | $691.83 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,467.37 / $5,623.41
| Facility | | $1,174.90 | $3,467.37 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $912.01 / $1,288.25
| Professional | | $616.60 | $912.01 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $933.25 / $1,380.38 / $1,949.84
| Professional | 50 | $933.25 | $1,380.38 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $194.98
| Professional | 55 | $128.82 | $128.82 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $758.58
| Facility | | $512.86 | $645.65 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $707.95
| Professional | | $676.08 | $676.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,348.96 / $1,659.59
| Facility | | $1,230.27 | $1,348.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $977.24 / $1,548.82
| Professional | | $524.81 | $977.24 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $758.58 / $2,089.30
| Professional | | $512.86 | $758.58 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $2,137.96
| Professional | 22 | $1,380.38 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $630.96
| Professional | 52 | $407.38 | $407.38 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $407.38 / $630.96 / $812.83
| Professional | 53 | $407.38 | $630.96 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $1,000.00
| Professional | 54 | $645.65 | $645.65 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $70.79
| Professional | 55 | $45.71 | $45.71 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,570.88 / $6,918.31
| Facility | | $2,454.71 | $4,570.88 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $776.25 / $1,479.11
| Professional | | $645.65 | $776.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,548.13 / $6,165.95
| Facility | | $1,174.90 | $3,548.13 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $794.33 / $1,348.96
| Professional | | $537.03 | $794.33 | $1,348.96 |