- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,148.15 / $6,456.54
| Facility | | $213.80 | $1,148.15 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $562.34
| Professional | | $154.88 | $245.47 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $199.53 / $398.11
| Professional | | $158.49 | $199.53 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $4,168.69 / $12,302.69
| Facility | | $194.98 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $194.98 / $234.42
| Professional | | $169.82 | $194.98 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $309.03
| Facility | | $120.23 | $120.23 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 54 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $213.80 / $354.81
| Professional | | $151.36 | $213.80 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,090.30 / $6,309.57
| Facility | | $2,041.74 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $165.96 / $245.47
| Professional | | $154.88 | $165.96 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $177.83 / $323.59
| Professional | | $32.36 | $177.83 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,445.44 / $3,630.78
| Facility | | $316.23 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $181.97 / $331.13
| Professional | | $131.83 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $165.96 / $229.09
| Professional | | $141.25 | $165.96 | $229.09 |