- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,511.89 / $6,760.83
| Facility | | $398.11 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $812.83
| Professional | | $223.87 | $323.59 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $616.60 / $812.83
| Professional | | $269.15 | $616.60 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $851.14
| Professional | | $213.80 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $575.44 / $1,202.26
| Facility | | $288.40 | $575.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | 54 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $1,905.46
| Professional | | $263.03 | $537.03 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $616.60 / $724.44
| Professional | | $524.81 | $616.60 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $512.86 / $724.44
| Professional | | $457.09 | $512.86 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $467.74 / $630.96
| Professional | | $263.03 | $467.74 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $758.58 / $2,344.23
| Facility | | $371.54 | $758.58 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $707.95
| Professional | | $229.09 | $346.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $537.03 / $630.96
| Professional | | $426.58 | $537.03 | $630.96 |