- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $489.78 / $4,466.84
| Facility | | $194.98 | $489.78 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $263.03 / $524.81
| Professional | | $177.83 | $263.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $190.55 / $295.12 / $575.44
| Professional | 54 | $190.55 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $257.04
| Professional | | $165.96 | $165.96 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $158.49
| Professional | 54 | $141.25 | $141.25 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $117.49
| Facility | | $114.82 | $114.82 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $602.56
| Professional | | $190.55 | $288.40 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $602.56
| Facility | | $234.42 | $234.42 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $251.19 / $436.52
| Professional | | $181.97 | $251.19 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $467.74
| Professional | | $281.84 | $281.84 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $239.88 / $371.54
| Facility | | $186.21 | $239.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $354.81 / $457.09
| Professional | | $295.12 | $354.81 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $724.44 / $1,949.84
| Facility | | $194.98 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $204.17 / $407.38
| Professional | | $154.88 | $204.17 | $407.38 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,951.21 / $2,951.21
| Facility | | $56.23 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | 54 | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,819.70
| Professional | | $1,548.82 | $1,548.82 | $1,819.70 |