- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $3,019.95 / $8,128.31
| Facility | | $524.81 | $3,019.95 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $380.19 / $741.31
| Professional | | $257.04 | $380.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $660.69
| Professional | | $269.15 | $363.08 | $660.69 |
- 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
- $269.15 / $309.03 / $363.08
| Professional | | $269.15 | $309.03 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $138.04 / $489.78
| Facility | | $128.82 | $138.04 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | 54 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $380.19 / $602.56
| Professional | | $251.19 | $380.19 | $602.56 |
- 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
- $162.18 / $269.15 / $354.81
| Professional | | $162.18 | $269.15 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $251.19 / $512.86
| Professional | | $32.36 | $251.19 | $512.86 |
- 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
- $218.78 / $302.00 / $562.34
| Professional | | $218.78 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $251.19 / $363.08
| Professional | | $229.09 | $251.19 | $363.08 |