- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $524.81 / $6,606.93
| Facility | | $288.40 | $524.81 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $275.42 / $489.78
| Professional | | $177.83 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $389.05
| Professional | 54 | $190.55 | $288.40 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $562.34
| Professional | | $229.09 | $380.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $489.78 / $575.44
| Professional | | $398.11 | $489.78 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $467.74
| Facility | | $194.98 | $302.00 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $549.54
| Professional | | $269.15 | $380.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $302.00
| Professional | 54 | $190.55 | $269.15 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $416.87
| Facility | | $229.09 | $380.19 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $457.09
| Facility | | $194.98 | $302.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $380.19 / $549.54
| Professional | | $79.43 | $380.19 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $891.25
| Facility | | $562.34 | $812.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $446.68 / $602.56
| Professional | | $309.03 | $446.68 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,071.52 / $5,128.61
| Facility | | $676.08 | $1,071.52 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $363.08 / $537.03
| Professional | | $239.88 | $363.08 | $537.03 |