- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $5,888.44 / $9,772.37
| Facility | | $1,071.52 | $5,888.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,318.26 / $6,456.54 / $11,481.54
| Facility | 50 | $1,318.26 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $707.95 / $6,025.60
| Professional | | $489.78 | $707.95 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,187.76
| Professional | 50 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $398.11 / $616.60 / $1,348.96
| Professional | 54 | $398.11 | $616.60 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $7.76 / $128.82 / $851.14
| Professional | 55 | $7.76 | $128.82 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $575.44 / $691.83
| Professional | | $467.74 | $575.44 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | 50 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,311.31 / $7,244.36
| Facility | | $1,000.00 | $3,311.31 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $724.44 / $1,348.96
| Professional | | $562.34 | $724.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $851.14 / $1,096.48 / $1,949.84
| Professional | 50 | $851.14 | $1,096.48 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $537.03 / $676.08
| Facility | | $489.78 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $630.96 / $1,174.90
| Professional | | $489.78 | $630.96 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $724.44 / $1,380.38
| Professional | | $457.09 | $724.44 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $7,585.78
| Facility | | $1,819.70 | $3,630.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $660.69 / $1,202.26
| Professional | | $338.84 | $660.69 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $1,071.52
| Professional | 54 | $354.81 | $467.74 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $7.59 / $30.20 / $114.82
| Professional | 55 | $7.59 | $30.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $512.86
| Professional | | $32.36 | $33.11 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $1,698.24 / $2,818.38
| Facility | | $100.00 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $707.95 / $1,148.15
| Professional | | $467.74 | $707.95 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,265.80 / $7,244.36
| Facility | | $1,737.80 | $4,265.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $660.69 / $1,071.52
| Professional | | $467.74 | $660.69 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | 55 | $89.13 | $89.13 | $89.13 |