- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $549.54 / $3,630.78
| Facility | | $234.42 | $549.54 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $467.74 / $489.78 / $2,511.89
| Facility | 54 | $467.74 | $489.78 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $302.00 / $691.83
| Professional | | $234.42 | $302.00 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $676.08 / $2,818.38
| Facility | | $56.23 | $676.08 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | 54 | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $398.11 / $1,096.48
| Professional | | $234.42 | $398.11 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $758.58
| Facility | | $331.13 | $331.13 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $524.81
| Facility | 54 | $229.09 | $229.09 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $794.33
| Professional | | $331.13 | $501.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $812.83
| Professional | | $239.88 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $426.58 / $3,311.31
| Facility | | $295.12 | $426.58 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $489.78 / $645.65
| Professional | | $407.38 | $489.78 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $575.44 / $933.25
| Professional | | $346.74 | $575.44 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $346.74
| Facility | | $251.19 | $331.13 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $512.86 / $537.03
| Professional | | $416.87 | $512.86 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $676.08 / $2,818.38
| Facility | | $56.23 | $676.08 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | 54 | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $398.11 / $1,096.48
| Professional | | $234.42 | $398.11 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,698.24 / $2,818.38
| Facility | | $501.19 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $954.99
| Professional | | $263.03 | $436.52 | $954.99 |