- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,041.74 / $6,918.31
| Facility | | $524.81 | $2,041.74 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $501.19 / $891.25
| Professional | | $407.38 | $501.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $562.34 / $1,047.13
| Professional | | $302.00 | $562.34 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,187.76 / $4,265.80
| Facility | | $1,148.15 | $2,187.76 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $489.78 / $707.95
| Professional | | $371.54 | $489.78 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $676.08 / $4,073.80
| Facility | | $83.18 | $676.08 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $457.09
| Facility | | $407.38 | $407.38 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $537.03
| Facility | 54 | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $977.24
| Professional | | $436.52 | $602.56 | $977.24 |
- 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
- $3,630.78 / $4,365.16 / $4,365.16
| Professional | | $3,630.78 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $660.69 / $2,290.87
| Facility | | $467.74 | $660.69 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,071.52
| Professional | | $426.58 | $660.69 | $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 / $1,778.28 / $2,238.72
| Professional | | $645.65 | $1,778.28 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $616.60 / $1,000.00
| Facility | | $457.09 | $616.60 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | 54 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $602.56 / $954.99
| Professional | | $446.68 | $602.56 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,513.56 / $3,630.78
| Facility | | $446.68 | $1,513.56 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $489.78 / $758.58
| Professional | | $371.54 | $489.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $575.44 / $602.56
| Professional | | $562.34 | $575.44 | $602.56 |