- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $5,011.87 / $9,549.93
| Facility | | $912.01 | $5,011.87 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 53 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | 54 | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $707.95 / $2,570.40
| Professional | | $467.74 | $707.95 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $724.44 / $758.58 / $2,187.76
| Professional | 50 | $724.44 | $758.58 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $407.38 / $501.19 / $1,479.11
| Professional | 54 | $407.38 | $501.19 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $28.18 / $100.00 / $831.76
| Professional | 55 | $28.18 | $100.00 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $537.03 / $1,148.15
| Professional | | $489.78 | $537.03 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,202.26 / $1,202.26
| Professional | | $630.96 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Professional | 50 | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $512.86 / $676.08
| Facility | | $501.19 | $512.86 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,318.26
| Professional | | $426.58 | $660.69 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $4,897.79 / $8,317.64
| Facility | | $758.58 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 53 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | 54 | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $776.25 / $1,412.54
| Professional | | $512.86 | $776.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $724.44 / $758.58 / $2,187.76
| Professional | 50 | $724.44 | $758.58 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $398.11 / $501.19 / $1,479.11
| Professional | 54 | $398.11 | $501.19 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $28.18 / $100.00 / $831.76
| Professional | 55 | $28.18 | $100.00 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,148.15
| Professional | | $426.58 | $660.69 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,981.07 / $7,413.10
| Facility | | $1,819.70 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $758.58 / $1,023.29
| Professional | | $537.03 | $758.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | 54 | $89.13 | $89.13 | $89.13 |