- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $5,495.41 / $10,000.00
| Facility | | $2,089.30 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $812.83 / $1,905.46
| Professional | | $331.13 | $812.83 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $426.58 / $524.81 / $1,513.56
| Professional | 54 | $426.58 | $524.81 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $8.91 / $199.53 / $851.14
| Professional | 55 | $8.91 | $199.53 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $3,162.28 / $6,025.60
| Facility | | $1,318.26 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,089.30 / $4,677.35 / $9,120.11
| Facility | 50 | $2,089.30 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,023.29 / $1,122.02
| Professional | | $870.96 | $1,023.29 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,288.25 / $1,548.82 / $1,621.81
| Professional | 50 | $1,288.25 | $1,548.82 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $660.69 / $831.76 / $870.96
| Professional | 54 | $660.69 | $831.76 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $165.96 / $204.17 / $218.78
| Professional | 55 | $165.96 | $204.17 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $776.25 / $1,023.29
| Professional | | $426.58 | $776.25 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,659.59 / $9,549.93
| Facility | | $776.25 | $1,659.59 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $831.76 / $1,288.25
| Professional | | $467.74 | $831.76 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $426.58 / $512.86 / $1,230.27
| Professional | 54 | $426.58 | $512.86 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $8.91 / $47.86 / $851.14
| Professional | 55 | $8.91 | $47.86 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $5,248.07 / $7,585.78
| Facility | | $4,073.80 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $6,309.57 / $8,709.64 / $11,220.18
| Facility | 50 | $6,309.57 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,071.52 / $1,148.15
| Professional | | $912.01 | $1,071.52 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $912.01 / $2,884.03
| Professional | | $436.52 | $912.01 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $12,302.69 / $12,302.69
| Facility | | $1,148.15 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $831.76 / $1,288.25
| Professional | | $645.65 | $831.76 | $1,288.25 |