- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $870.96 / $5,011.87
| Facility | | $331.13 | $870.96 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Facility | 54 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $398.11 / $812.83
| Professional | | $281.84 | $398.11 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $724.44 / $1,023.29
| Professional | | $316.23 | $724.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $436.52 / $1,445.44
| Professional | | $257.04 | $436.52 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $645.65 / $1,445.44
| Facility | | $323.59 | $645.65 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | 52 | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 54 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $660.69 / $2,290.87
| Professional | | $316.23 | $660.69 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $912.01
| Professional | | $575.44 | $724.44 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $616.60 / $912.01
| Professional | | $537.03 | $616.60 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $676.08 / $912.01
| Professional | | $380.19 | $676.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $758.58 / $2,344.23
| Facility | | $371.54 | $758.58 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $407.38 / $812.83
| Professional | | $281.84 | $407.38 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $676.08 / $794.33
| Professional | | $537.03 | $676.08 | $794.33 |