- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,819.70 / $4,570.88
| Facility | | $512.86 | $1,819.70 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $870.96 / $1,412.54 / $1,479.11
| Facility | 54 | $870.96 | $1,412.54 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $660.69 / $1,513.56
| Professional | | $478.63 | $660.69 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,818.38 / $45,708.82
| Facility | | $1,148.15 | $2,818.38 | $45,708.82 |
- 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
- $478.63 / $794.33 / $2,041.74
| Professional | | $478.63 | $794.33 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $1,445.44
| Facility | | $630.96 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $1,000.00
| Facility | 54 | $436.52 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,023.29 / $1,513.56
| Professional | | $630.96 | $1,023.29 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $812.83 / $1,548.82
| Professional | | $524.81 | $812.83 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $794.33 / $3,630.78
| Facility | | $562.34 | $794.33 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $870.96 / $1,122.02
| Professional | | $724.44 | $870.96 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,511.89 / $7,079.46
| Facility | | $1,288.25 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,071.52 / $1,659.59
| Professional | | $645.65 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $660.69 / $1,949.84
| Facility | | $338.84 | $660.69 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $851.14 / $1,023.29
| Professional | | $562.34 | $851.14 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,818.38 / $45,708.82
| Facility | | $1,148.15 | $2,818.38 | $45,708.82 |
- 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
- $478.63 / $794.33 / $2,041.74
| Professional | | $478.63 | $794.33 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,454.71 / $6,165.95
| Facility | | $954.99 | $2,454.71 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $851.14 / $1,737.80
| Professional | | $549.54 | $851.14 | $1,737.80 |