- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,621.81 / $6,606.93
| Facility | | $251.19 | $1,621.81 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $407.38
| Professional | | $162.18 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 54 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,318.26 / $2,089.30
| Facility | | $831.76 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $275.42
| Professional | | $177.83 | $234.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $229.09 / $316.23
| Professional | | $134.90 | $229.09 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $263.03 / $1,513.56
| Facility | | $177.83 | $263.03 | $1,513.56 |
- 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
- $162.18 / $218.78 / $1,548.82
| Professional | | $162.18 | $218.78 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $549.54 / $1,548.82
| Facility | | $138.04 | $549.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $186.21 / $257.04
| Professional | | $144.54 | $186.21 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $87.10 / $89.13 / $354.81
| Professional | 54 | $87.10 | $89.13 | $354.81 |