- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $2,818.38 / $8,128.31
| Facility | | $501.19 | $2,818.38 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $407.38 / $724.44
| Professional | | $309.03 | $407.38 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Professional | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,905.46 / $11,220.18
| Facility | | $257.04 | $1,905.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $380.19 / $446.68
| Professional | | $331.13 | $380.19 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $131.83 / $602.56
| Facility | | $128.82 | $131.83 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | 54 | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $457.09 / $724.44
| Professional | | $302.00 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,466.84
| Facility | | $1,698.24 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $446.68
| Professional | | $194.98 | $331.13 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $309.03 / $630.96
| Professional | | $32.36 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,445.44 / $3,630.78
| Facility | | $251.19 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $691.83
| Professional | | $263.03 | $363.08 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $309.03 / $457.09
| Professional | | $281.84 | $309.03 | $457.09 |