- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,380.38 / $7,244.36
| Facility | | $354.81 | $1,380.38 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $338.84 / $691.83 / $891.25
| Facility | 54 | $338.84 | $691.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $851.14
| Professional | | $281.84 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $1,047.13 / $1,380.38
| Professional | 50 | $691.83 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $794.33
| Professional | 54 | $281.84 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $4,570.88 / $10,471.29
| Facility | | $1,584.89 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $758.58
| Professional | | $245.47 | $380.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $1,122.02
| Professional | 50 | $354.81 | $549.54 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $1,047.13 / $3,162.28
| Facility | | $128.82 | $1,047.13 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 54 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $446.68 / $1,000.00
| Professional | | $288.40 | $446.68 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $1,000.00 / $3,311.31
| Facility | | $208.93 | $1,000.00 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $812.83
| Professional | | $245.47 | $363.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $85.11 / $87.10 / $89.13
| Professional | 54 | $85.11 | $87.10 | $89.13 |