- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,548.13 / $6,606.93
| Facility | | $1,819.70 | $3,548.13 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | 50 | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $758.58 / $3,162.28
| Professional | | $407.38 | $758.58 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $2,187.76
| Professional | 50 | $776.25 | $776.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $398.11 / $537.03 / $1,047.13
| Professional | 54 | $398.11 | $537.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $7.76 / $245.47 / $1,047.13
| Professional | 55 | $7.76 | $245.47 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $4,265.80 / $11,220.18
| Facility | | $1,288.25 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 53 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | 54 | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | 55 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $891.25 / $6,309.57
| Professional | | $489.78 | $891.25 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,096.48 / $1,445.44
| Professional | | $645.65 | $1,096.48 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,995.26 / $2,137.96 / $2,137.96
| Professional | 50 | $1,995.26 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $316.23 / $537.03 / $724.44
| Professional | 52 | $316.23 | $537.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $446.68 / $741.31 / $1,023.29
| Professional | 54 | $446.68 | $741.31 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $128.82 / $218.78 / $288.40
| Professional | 55 | $128.82 | $218.78 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $954.99 / $2,041.74
| Professional | | $501.19 | $954.99 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $691.83 / $5,248.07
| Facility | | $478.63 | $691.83 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $616.60 / $794.33
| Professional | | $524.81 | $616.60 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,265.80 / $9,772.37
| Facility | | $2,041.74 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $851.14 / $1,513.56
| Professional | | $478.63 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,290.87 / $8,511.38
| Facility | | $1,258.93 | $2,290.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $851.14 / $1,698.24
| Professional | | $630.96 | $851.14 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $4,265.80 / $11,220.18
| Facility | | $1,288.25 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 53 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | 54 | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | 55 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $891.25 / $6,309.57
| Professional | | $489.78 | $891.25 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $2,951.21 / $4,365.16
| Facility | | $407.38 | $2,951.21 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $588.84 / $1,000.00
| Professional | | $295.12 | $588.84 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,890.45 / $8,709.64
| Facility | | $1,698.24 | $3,890.45 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $933.25 / $1,778.28
| Professional | | $562.34 | $933.25 | $1,778.28 |