- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $5,370.32 / $11,481.54
| Facility | | $891.25 | $5,370.32 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $16,982.44 / $16,982.44 / $16,982.44
| Facility | 50 | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $676.08 / $2,344.23
| Professional | | $288.40 | $676.08 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $724.44 / $2,187.76 / $4,365.16
| Professional | 50 | $724.44 | $2,187.76 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $234.42 / $512.86 / $1,230.27
| Professional | 54 | $234.42 | $512.86 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $199.53
| Professional | 55 | $72.44 | $102.33 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $10,000.00
| Facility | | $2,630.27 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $1,621.81
| Professional | | $512.86 | $645.65 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $977.24 / $2,398.83
| Professional | 50 | $776.25 | $977.24 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,388.44 / $13,803.84
| Facility | | $758.58 | $3,388.44 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $4,168.69 / $53,703.18
| Facility | | $891.25 | $4,168.69 | $53,703.18 |
- 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
- $446.68 / $870.96 / $2,754.23
| Professional | | $446.68 | $870.96 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $812.83 / $1,778.28
| Facility | | $537.03 | $812.83 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $707.95 / $891.25
| Professional | | $524.81 | $707.95 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $676.08 / $1,148.15
| Professional | | $436.52 | $676.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $338.84 / $549.54 / $912.01
| Professional | 54 | $338.84 | $549.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $85.11 / $138.04 / $229.09
| Professional | 55 | $85.11 | $138.04 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,570.88 / $13,182.57
| Facility | | $2,344.23 | $4,570.88 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $7,585.78
| Facility | 50 | $4,168.69 | $4,168.69 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $724.44 / $724.44
| Professional | | $676.08 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $2,630.27
| Professional | 50 | $1,071.52 | $1,071.52 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | 54 | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $50,118.72 / $75,857.76
| Facility | | $954.99 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $676.08 / $1,096.48
| Professional | | $398.11 | $676.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,981.07 / $8,709.64
| Facility | | $2,041.74 | $3,981.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $645.65 / $1,023.29
| Professional | | $524.81 | $645.65 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $741.31 / $2,344.23
| Facility | | $436.52 | $741.31 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $354.81 / $398.11 / $588.84
| Facility | 54 | $354.81 | $398.11 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $147.91
| Facility | 55 | $89.13 | $114.82 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $676.08 / $2,187.76
| Professional | | $436.52 | $676.08 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $354.81 / $478.63 / $912.01
| Professional | 54 | $354.81 | $478.63 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $269.15
| Professional | 55 | $89.13 | $134.90 | $269.15 |