- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $3,388.44 / $6,165.95
| Facility | | $660.69 | $3,388.44 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $1,258.93
| Professional | | $478.63 | $741.31 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $3,981.07 / $11,220.18
| Facility | | $1,122.02 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | 54 | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $794.33 / $2,041.74
| Professional | | $489.78 | $794.33 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $1,288.25
| Facility | | $562.34 | $562.34 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $977.24 / $1,479.11
| Professional | | $562.34 | $977.24 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $954.99 / $1,819.70
| Professional | | $457.09 | $954.99 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $616.60 / $4,897.79
| Facility | | $436.52 | $616.60 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $912.01 / $1,174.90
| Professional | | $776.25 | $912.01 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,265.80 / $9,772.37
| Facility | | $2,041.74 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $812.83 / $1,778.28
| Professional | | $501.19 | $812.83 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,890.45 / $5,888.44
| Facility | | $1,000.00 | $3,890.45 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $758.58 / $1,122.02
| Professional | | $676.08 | $758.58 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $3,981.07 / $11,220.18
| Facility | | $1,122.02 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | 54 | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $794.33 / $2,041.74
| Professional | | $489.78 | $794.33 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,890.45 / $8,709.64
| Facility | | $1,698.24 | $3,890.45 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $851.14 / $1,819.70
| Professional | | $501.19 | $851.14 | $1,819.70 |