- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,511.89 / $21,877.62
| Facility | | $758.58 | $2,511.89 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,047.13 / $1,995.26
| Professional | | $724.44 | $1,047.13 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Professional | 54 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | 55 | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,584.89 / $1,862.09
| Professional | | $1,288.25 | $1,584.89 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $891.25 / $1,122.02 / $1,318.26
| Professional | 54 | $891.25 | $1,122.02 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,380.38 / $2,290.87
| Professional | | $812.83 | $1,380.38 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,258.93 / $2,238.72
| Facility | | $758.58 | $1,258.93 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,380.38 / $6,918.31
| Professional | | $758.58 | $1,380.38 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,122.02 / $1,148.15 / $1,148.15
| Professional | 54 | $1,122.02 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,677.35 / $5,128.61
| Facility | | $2,570.40 | $4,677.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,202.26 / $2,041.74
| Professional | | $758.58 | $1,202.26 | $2,041.74 |