- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,479.11 / $3,715.35
| Facility | | $302.00 | $1,479.11 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $407.38 / $812.83
| Professional | | $275.42 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,023.29 / $19,498.45
| Facility | | $467.74 | $1,023.29 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | 54 | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $1,202.26
| Professional | | $263.03 | $436.52 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $831.76
| Facility | | $363.08 | $363.08 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $575.44
| Facility | 54 | $251.19 | $251.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $549.54 / $851.14
| Professional | | $363.08 | $549.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $467.74 / $891.25
| Professional | | $288.40 | $467.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $3,311.31
| Facility | | $302.00 | $426.58 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $489.78 / $616.60
| Professional | | $398.11 | $489.78 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $912.01
| Professional | | $354.81 | $562.34 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $588.84 / $630.96
| Facility | | $302.00 | $588.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $512.86 / $1,000.00
| Professional | | $316.23 | $512.86 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,023.29 / $19,498.45
| Facility | | $467.74 | $1,023.29 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | 54 | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $1,202.26
| Professional | | $263.03 | $436.52 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,698.24 / $2,818.38
| Facility | | $501.19 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $467.74 / $933.25
| Professional | | $302.00 | $467.74 | $933.25 |