- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $602.56 / $12,022.64
| Facility | | $229.09 | $602.56 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | 54 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $537.03
| Professional | | $177.83 | $269.15 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $120.23 / $338.84 / $380.19
| Professional | 54 | $120.23 | $338.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $616.60
| Professional | | $204.17 | $295.12 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $954.99
| Facility | | $186.21 | $309.03 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | 54 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $645.65 / $1,096.48
| Professional | | $269.15 | $645.65 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $120.23 / $346.74 / $1,862.09
| Professional | 54 | $120.23 | $346.74 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $851.14 / $1,148.15
| Professional | | $741.31 | $851.14 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $309.03 / $1,000.00
| Facility | | $177.83 | $309.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $269.15 / $588.84
| Professional | | $60.26 | $269.15 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $537.03 / $1,023.29
| Professional | | $186.21 | $537.03 | $1,023.29 |