- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $537.03 / $6,165.95
| Facility | | $275.42 | $537.03 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $630.96
| Facility | 54 | $354.81 | $467.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $630.96
| Professional | | $234.42 | $288.40 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $5,754.40 / $9,120.11
| Facility | | $1,659.59 | $5,754.40 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $295.12
| Professional | | $275.42 | $275.42 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $426.58 / $501.19
| Professional | | $380.19 | $426.58 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $323.59 / $537.03
| Professional | | $239.88 | $323.59 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $588.84 / $741.31
| Professional | | $436.52 | $588.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $602.56
| Professional | | $245.47 | $416.87 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $562.34 / $977.24
| Facility | | $316.23 | $562.34 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $331.13 / $371.54
| Professional | | $309.03 | $331.13 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $4,365.16 / $7,943.28
| Facility | | $331.13 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $295.12
| Professional | | $275.42 | $275.42 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $537.03 / $6,165.95
| Facility | | $275.42 | $537.03 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $323.59 / $645.65
| Professional | | $239.88 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $426.58 / $691.83
| Professional | | $323.59 | $426.58 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $288.40 / $407.38
| Facility | | $53.70 | $288.40 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $288.40 / $467.74
| Professional | | $53.70 | $288.40 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $676.08 / $3,890.45
| Facility | | $354.81 | $676.08 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $549.54
| Professional | | $218.78 | $309.03 | $549.54 |