- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,090.30 / $8,912.51
| Facility | | $602.56 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $537.03 / $977.24
| Professional | | $436.52 | $537.03 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,905.46 / $11,220.18
| Facility | | $257.04 | $1,905.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $537.03 / $616.60
| Professional | | $467.74 | $537.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $138.04 / $851.14
| Facility | | $128.82 | $138.04 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | 54 | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $645.65 / $1,023.29
| Professional | | $426.58 | $645.65 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,466.84
| Facility | | $1,698.24 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $467.74 / $602.56
| Professional | | $281.84 | $467.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $416.87 / $851.14
| Professional | | $32.36 | $416.87 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,445.44 / $3,630.78
| Facility | | $251.19 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $524.81 / $977.24
| Professional | | $380.19 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $416.87 / $616.60
| Professional | | $398.11 | $416.87 | $616.60 |