- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $2,884.03 / $9,332.54
| Facility | | $616.60 | $2,884.03 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | 55 | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $707.95 / $2,511.89
| Professional | | $457.09 | $707.95 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Professional | 50 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $407.38 / $1,479.11 / $1,479.11
| Professional | 54 | $407.38 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $7.59 / $245.47 / $1,047.13
| Professional | 55 | $7.59 | $245.47 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $446.68 / $616.60
| Professional | | $275.42 | $446.68 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Professional | 50 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $5,128.61 / $9,549.93
| Facility | | $2,570.40 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $691.83 / $1,445.44
| Professional | | $575.44 | $691.83 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $851.14 / $1,047.13 / $2,187.76
| Professional | 50 | $851.14 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Professional | 54 | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $645.65 / $776.25
| Facility | | $489.78 | $645.65 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $588.84 / $776.25
| Professional | | $489.78 | $588.84 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $4,168.69
| Facility | | $891.25 | $891.25 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | 22 | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | 53 | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | 54 | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | 55 | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,000.00 / $6,309.57
| Professional | | $537.03 | $1,000.00 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $316.23
| Professional | | $32.36 | $33.11 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,467.37 / $6,025.60
| Facility | | $602.56 | $3,467.37 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $707.95 / $1,122.02
| Professional | | $524.81 | $707.95 | $1,122.02 |