- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $616.60 / $11,481.54
| Facility | | $363.08 | $616.60 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $251.19 / $588.84
| Professional | | $177.83 | $251.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $213.80 / $257.04 / $758.58
| Professional | 54 | $213.80 | $257.04 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | 54 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $630.96 / $1,288.25
| Facility | | $426.58 | $630.96 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $389.05 / $537.03
| Professional | | $263.03 | $389.05 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $363.08
| Facility | | $302.00 | $302.00 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $602.56
| Professional | | $186.21 | $338.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $288.40 / $537.03
| Facility | | $177.83 | $288.40 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $302.00 / $501.19
| Professional | | $177.83 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $107.15
| Professional | | $32.36 | $33.11 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $380.19 / $426.58
| Facility | | $257.04 | $380.19 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $288.40
| Facility | | $234.42 | $275.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $363.08 / $537.03
| Professional | | $275.42 | $363.08 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,288.25
| Facility | | $426.58 | $660.69 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $389.05 / $524.81
| Professional | | $263.03 | $389.05 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $851.14 / $1,949.84
| Facility | | $229.09 | $851.14 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $524.81
| Professional | | $208.93 | $275.42 | $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
- $234.42 / $275.42 / $446.68
| Professional | | $234.42 | $275.42 | $446.68 |