- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $741.31 / $4,365.16
| Facility | | $645.65 | $741.31 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $741.31 / $1,380.38
| Professional | | $562.34 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Professional | 54 | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,621.81 / $2,041.74
| Professional | | $1,258.93 | $1,621.81 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $794.33 / $1,698.24
| Facility | | $524.81 | $794.33 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,288.25 / $4,466.84
| Professional | | $575.44 | $1,288.25 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $1,949.84
| Professional | 50 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,071.52
| Professional | 54 | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,584.89 / $1,659.59
| Professional | | $1,412.54 | $1,584.89 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,122.02 / $1,348.96
| Professional | | $707.95 | $1,122.02 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,202.26 / $1,862.09
| Professional | | $602.56 | $1,202.26 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,380.38 / $1,584.89
| Professional | | $1,122.02 | $1,380.38 | $1,584.89 |