- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $2,290.87 / $7,585.78
| Facility | | $537.03 | $2,290.87 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $512.86 / $831.76
| Professional | | $426.58 | $512.86 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $2,187.76 / $4,168.69
| Facility | | $1,096.48 | $2,187.76 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $537.03 / $776.25
| Professional | | $426.58 | $537.03 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $457.09 / $467.74
| Facility | | $79.43 | $457.09 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 54 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $630.96 / $1,000.00
| Professional | | $457.09 | $630.96 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $19,498.45 / $19,498.45
| Facility | | $4,897.79 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | 54 | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $4,466.84 / $4,466.84
| Professional | | $3,715.35 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $660.69 / $2,398.83
| Facility | | $467.74 | $660.69 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $676.08 / $1,071.52
| Professional | | $436.52 | $676.08 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $380.19 / $457.09
| Professional | | $32.36 | $380.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Professional | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $616.60 / $1,023.29
| Facility | | $467.74 | $616.60 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | 54 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $616.60 / $977.24
| Professional | | $457.09 | $616.60 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $1,047.13 / $2,454.71
| Facility | | $173.78 | $1,047.13 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $501.19 / $776.25
| Professional | | $380.19 | $501.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $575.44 / $602.56
| Professional | | $562.34 | $575.44 | $602.56 |