- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $758.58 / $7,943.28
| Facility | | $436.52 | $758.58 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $426.58 / $741.31
| Professional | | $263.03 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $309.03 / $398.11 / $724.44
| Professional | 54 | $309.03 | $398.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $575.44 / $831.76
| Professional | | $338.84 | $575.44 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $851.14
| Professional | | $575.44 | $724.44 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $676.08
| Facility | | $281.84 | $436.52 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $549.54 / $794.33
| Professional | | $407.38 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $724.44
| Professional | 54 | $316.23 | $398.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $575.44 / $630.96
| Facility | | $354.81 | $575.44 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $676.08
| Facility | | $275.42 | $436.52 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $575.44 / $831.76
| Professional | | $79.43 | $575.44 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $891.25
| Facility | | $562.34 | $812.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $676.08 / $912.01
| Professional | | $457.09 | $676.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,071.52 / $5,128.61
| Facility | | $676.08 | $1,071.52 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $537.03 / $794.33
| Professional | | $354.81 | $537.03 | $794.33 |