- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $10,232.93 / $22,908.68
| Facility | | $4,365.16 | $10,232.93 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $691.83 / $1,995.26
| Professional | | $575.44 | $691.83 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Professional | 55 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $676.08
| Professional | | $616.60 | $616.60 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $13,489.63 / $22,387.21
| Facility | | $7,943.28 | $13,489.63 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,122.02 / $2,238.72
| Professional | | $794.33 | $1,122.02 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $1,412.54 / $7,762.47
| Facility | | $85.11 | $1,412.54 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $912.01 / $1,995.26
| Professional | | $676.08 | $912.01 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $5,370.32 / $7,244.36
| Facility | | $707.95 | $5,370.32 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $912.01 / $1,778.28
| Professional | | $691.83 | $912.01 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $776.25 / $954.99
| Professional | | $588.84 | $776.25 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $724.44 / $1,445.44
| Professional | | $549.54 | $724.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $22,387.21
| Facility | | $54.95 | $56.23 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | 53 | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | 54 | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | 55 | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $5,623.41 / $5,623.41
| Professional | | $4,897.79 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $812.83 / $1,318.26
| Facility | | $630.96 | $812.83 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $933.25 / $1,862.09
| Professional | | $691.83 | $933.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $776.25 / $1,000.00
| Professional | | $575.44 | $776.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $11,748.98 / $25,118.86
| Facility | | $6,309.57 | $11,748.98 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $741.31 / $1,737.80
| Professional | | $549.54 | $741.31 | $1,737.80 |