- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $2,511.89 / $6,760.83
| Facility | | $389.05 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $288.40 / $660.69
| Professional | | $223.87 | $288.40 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $630.96 / $831.76
| Professional | | $269.15 | $630.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $354.81 / $724.44
| Professional | | $213.80 | $354.81 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $562.34 / $1,202.26
| Facility | | $288.40 | $562.34 | $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 / $1,862.09
| Professional | | $263.03 | $537.03 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $616.60 / $724.44
| Professional | | $537.03 | $616.60 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $512.86 / $724.44
| Professional | | $446.68 | $512.86 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $457.09 / $616.60
| Professional | | $257.04 | $457.09 | $616.60 |
- 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 / $338.84 / $676.08
| Professional | | $229.09 | $338.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $537.03 / $645.65
| Professional | | $426.58 | $537.03 | $645.65 |