- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,621.81 / $5,623.41
| Facility | | $316.23 | $1,621.81 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | 54 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $371.54 / $758.58
| Professional | | $281.84 | $371.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $478.63 / $537.03
| Professional | | $245.47 | $478.63 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,089.30 / $3,981.07
| Facility | | $741.31 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $630.96
| Professional | | $275.42 | $436.52 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $645.65
| Facility | | $177.83 | $177.83 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $794.33
| Professional | | $302.00 | $446.68 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $512.86 / $776.25
| Professional | | $416.87 | $512.86 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $295.12
| Professional | 52 | $269.15 | $269.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $478.63
| Professional | 54 | $426.58 | $426.58 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $707.95 / $831.76
| Professional | | $616.60 | $707.95 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,318.26 / $2,344.23
| Facility | | $213.80 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $371.54 / $707.95
| Professional | | $251.19 | $371.54 | $707.95 |