- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,786.30 / $8,317.64
| Facility | | $2,137.96 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $588.84 / $1,071.52
| Professional | | $512.86 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $630.96 / $831.76
| Facility | | $562.34 | $630.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $588.84 / $1,174.90
| Professional | | $489.78 | $588.84 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $4,168.69
| Facility | | $891.25 | $891.25 | $4,168.69 |
- 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
- $489.78 / $812.83 / $6,309.57
| Professional | | $489.78 | $812.83 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,456.54 / $9,549.93
| Facility | | $3,548.13 | $6,456.54 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $19,054.61
| Facility | 50 | $2,511.89 | $2,511.89 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | 55 | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $812.83 / $1,258.93
| Professional | | $758.58 | $812.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,862.09
| Professional | 50 | $1,288.25 | $1,288.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $537.03 / $562.34 / $870.96
| Professional | 54 | $537.03 | $562.34 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $144.54 / $251.19 / $251.19
| Professional | 55 | $144.54 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $6,456.54
| Facility | | $2,454.71 | $2,454.71 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $676.08 / $1,071.52
| Professional | | $416.87 | $676.08 | $1,071.52 |