- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,949.84 / $5,754.40
| Facility | | $229.09 | $1,949.84 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 54 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $616.60
| Professional | | $173.78 | $281.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $407.38
| Professional | 54 | $154.88 | $309.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $123.03
| Professional | 54 | $117.49 | $117.49 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $204.17 / $309.03
| Professional | | $165.96 | $204.17 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $338.84
| Professional | | $208.93 | $251.19 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $398.11
| Professional | | $186.21 | $251.19 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $257.04 / $870.96
| Facility | | $144.54 | $257.04 | $870.96 |
- 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
- $190.55 / $309.03 / $1,548.82
| Professional | | $190.55 | $309.03 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $549.54 / $1,584.89
| Facility | | $194.98 | $549.54 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $218.78 / $354.81
| Professional | | $165.96 | $218.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | 54 | $87.10 | $87.10 | $87.10 |