- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $660.69 / $6,606.93
| Facility | | $323.59 | $660.69 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Facility | 54 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $275.42 / $588.84
| Professional | | $194.98 | $275.42 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $338.84 / $354.81 / $1,071.52
| Professional | 54 | $338.84 | $354.81 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $691.83
| Professional | | $218.78 | $316.23 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $1,230.27
| Facility | | $199.53 | $371.54 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Facility | 54 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $676.08 / $1,230.27
| Professional | | $288.40 | $676.08 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $194.98 / $354.81 / $1,096.48
| Professional | 54 | $194.98 | $354.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $912.01 / $1,258.93
| Professional | | $776.25 | $912.01 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $1,071.52
| Facility | | $194.98 | $331.13 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $295.12 / $645.65
| Professional | | $60.26 | $295.12 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $776.25 / $1,148.15
| Professional | | $204.17 | $776.25 | $1,148.15 |