- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $6,456.54 / $11,748.98
| Facility | | $1,412.54 | $6,456.54 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $912.01 / $3,467.37
| Professional | | $331.13 | $912.01 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $616.60 / $2,187.76 / $4,365.16
| Professional | 50 | $616.60 | $2,187.76 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $234.42 / $524.81 / $1,230.27
| Professional | 54 | $234.42 | $524.81 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $8.91 / $85.11 / $199.53
| Professional | 55 | $8.91 | $85.11 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $954.99 / $1,445.44
| Professional | | $645.65 | $954.99 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $977.24 / $1,122.02
| Professional | | $758.58 | $977.24 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,230.27 / $9,332.54
| Facility | | $602.56 | $1,230.27 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,047.13 / $1,698.24
| Professional | | $660.69 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $616.60 / $2,187.76 / $4,365.16
| Professional | 50 | $616.60 | $2,187.76 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $234.42 / $501.19 / $1,230.27
| Professional | 54 | $234.42 | $501.19 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $8.91 / $48.98 / $199.53
| Professional | 55 | $8.91 | $48.98 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,071.52 / $1,230.27
| Facility | | $758.58 | $1,071.52 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $954.99 / $1,548.82
| Facility | | $549.54 | $954.99 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $1,023.29 / $1,445.44
| Professional | | $79.43 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $7,943.28 / $9,332.54
| Facility | | $5,754.40 | $7,943.28 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $8,511.38 / $12,022.64 / $13,803.84
| Facility | 50 | $8,511.38 | $12,022.64 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,288.25 / $1,621.81
| Professional | | $954.99 | $1,288.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $9,120.11 / $12,022.64
| Facility | | $2,951.21 | $9,120.11 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $1,445.44
| Professional | | $794.33 | $1,071.52 | $1,445.44 |