- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $1,995.26 / $7,762.47
| Facility | | $245.47 | $1,995.26 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $263.03 / $316.23 / $446.68
| Facility | 54 | $263.03 | $316.23 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $257.04 / $537.03
| Professional | | $173.78 | $257.04 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $562.34
| Professional | 54 | $190.55 | $302.00 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $229.09 / $457.09
| Professional | | $147.91 | $229.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $602.56 / $1,548.82
| Facility | | $128.82 | $602.56 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 54 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $269.15 / $588.84
| Professional | | $181.97 | $269.15 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $1,000.00 / $3,311.31
| Facility | | $208.93 | $1,000.00 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $489.78
| Professional | | $154.88 | $223.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $87.10 / $89.13 / $89.13
| Professional | 54 | $87.10 | $89.13 | $89.13 |