- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,584.89 / $8,317.64
| Facility | | $316.23 | $1,584.89 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $426.58 / $758.58 / $758.58
| Facility | 54 | $426.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $380.19 / $724.44
| Professional | | $257.04 | $380.19 | $724.44 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $354.81
| Professional | | $316.23 | $316.23 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $446.68
| Professional | | $416.87 | $416.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $331.13 / $562.34
| Professional | | $229.09 | $331.13 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $562.34 / $707.95
| Professional | | $407.38 | $562.34 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $398.11 / $562.34
| Professional | | $229.09 | $398.11 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $660.69 / $1,122.02
| Facility | | $331.13 | $660.69 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $323.59 / $398.11
| Professional | | $263.03 | $323.59 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $138.04 / $208.93 / $213.80
| Professional | 54 | $138.04 | $208.93 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $363.08
| Professional | | $316.23 | $316.23 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,584.89 / $8,317.64
| Facility | | $316.23 | $1,584.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $346.74 / $645.65
| Professional | | $269.15 | $346.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $457.09 / $691.83
| Professional | | $269.15 | $457.09 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $218.78 / $302.00
| Facility | | $50.12 | $218.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $239.88 / $323.59
| Professional | | $50.12 | $239.88 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $676.08 / $3,890.45
| Facility | | $354.81 | $676.08 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $575.44
| Professional | | $229.09 | $316.23 | $575.44 |