- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $3,467.37 / $7,762.47
| Facility | | $977.24 | $3,467.37 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $660.69 / $3,467.37
| Professional | | $346.74 | $660.69 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,995.26 / $4,365.16 / $4,365.16
| Professional | 50 | $1,995.26 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $91.20 / $457.09 / $1,230.27
| Professional | 54 | $91.20 | $457.09 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $60.26 / $93.33 / $199.53
| Professional | 55 | $60.26 | $93.33 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46,773.51 / $75,857.76 / $95,499.26
| Facility | | $46,773.51 | $75,857.76 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $776.25 / $1,047.13
| Professional | | $645.65 | $776.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $954.99 / $1,318.26
| Facility | | $912.01 | $954.99 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $954.99 / $1,318.26
| Professional | | $912.01 | $954.99 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,000.00 / $2,398.83
| Facility | | $776.25 | $1,000.00 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $549.54 / $1,047.13
| Professional | | $79.43 | $549.54 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,445.44 / $4,677.35
| Facility | | $602.56 | $1,445.44 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $977.24 / $1,479.11
| Professional | | $630.96 | $977.24 | $1,479.11 |