- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $2,290.87 / $6,456.54
| Facility | | $323.59 | $2,290.87 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $263.03 / $588.84
| Professional | | $173.78 | $263.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $302.00 / $407.38 / $645.65
| Professional | 54 | $302.00 | $407.38 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $467.74 / $630.96
| Professional | | $204.17 | $467.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $616.60
| Professional | | $151.36 | $275.42 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $446.68 / $1,148.15
| Facility | | $229.09 | $446.68 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | 54 | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $407.38 / $1,445.44
| Professional | | $199.53 | $407.38 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $562.34
| Professional | | $398.11 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $389.05 / $562.34
| Professional | | $346.74 | $389.05 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $371.54 / $489.78
| Professional | | $204.17 | $371.54 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $758.58 / $2,344.23
| Facility | | $371.54 | $758.58 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $263.03 / $524.81
| Professional | | $173.78 | $263.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $89.13
| Professional | 54 | $87.10 | $87.10 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $416.87 / $489.78
| Professional | | $323.59 | $416.87 | $489.78 |