- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $2,754.23 / $7,943.28
| Facility | | $323.59 | $2,754.23 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $239.88 / $457.09
| Professional | | $162.18 | $239.88 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $213.80 / $323.59 / $758.58
| Professional | 54 | $213.80 | $323.59 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $380.19
| Professional | | $251.19 | $331.13 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $524.81
| Professional | 54 | $109.65 | $190.55 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $4,168.69 / $12,302.69
| Facility | | $229.09 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $204.17 / $234.42
| Professional | | $165.96 | $204.17 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $131.83 / $331.13
| Facility | | $128.82 | $131.83 | $331.13 |
- 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
- $154.88 / $239.88 / $389.05
| Professional | | $154.88 | $239.88 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,466.84
| Facility | | $1,698.24 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $239.88
| Professional | | $100.00 | $169.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $169.82 / $323.59
| Professional | | $32.36 | $169.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,445.44 / $3,630.78
| Facility | | $251.19 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $354.81
| Professional | | $134.90 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | 54 | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $165.96 / $245.47
| Professional | | $154.88 | $165.96 | $245.47 |