- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $3,162.28 / $5,495.41
| Facility | | $575.44 | $3,162.28 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $660.69 / $2,041.74
| Professional | | $489.78 | $660.69 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,187.76
| Professional | 50 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $1,258.93
| Professional | 54 | $602.56 | $602.56 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $4.17 / $6.03 / $36.31
| Professional | 55 | $4.17 | $6.03 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,122.02 / $1,380.38
| Professional | | $933.25 | $1,122.02 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,412.54 / $1,659.59 / $2,041.74
| Professional | 50 | $1,412.54 | $1,659.59 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $660.69 / $776.25 / $954.99
| Professional | 54 | $660.69 | $776.25 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,000.00 / $1,698.24
| Professional | | $602.56 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,071.52 / $2,511.89
| Facility | | $549.54 | $1,071.52 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,047.13 / $1,737.80
| Professional | | $707.95 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $831.76 / $851.14 / $851.14
| Professional | 54 | $831.76 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $41.69
| Professional | 55 | $22.91 | $22.91 | $41.69 |
- 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
- $562.34 / $891.25 / $1,479.11
| Professional | | $562.34 | $891.25 | $1,479.11 |