- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $3,548.13 / $7,413.10
| Facility | | $295.12 | $3,548.13 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $537.03
| Professional | | $194.98 | $281.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $851.14
| Professional | 54 | $257.04 | $338.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $223.87 / $309.03
| Professional | | $165.96 | $223.87 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,344.23 / $4,168.69
| Facility | | $758.58 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $436.52
| Professional | | $190.55 | $302.00 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $263.03 / $323.59
| Professional | | $199.53 | $263.03 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $2,511.89
| Facility | | $177.83 | $177.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $524.81
| Professional | | $208.93 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $512.86
| Professional | | $234.42 | $309.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $309.03
| Professional | 54 | $288.40 | $288.40 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $363.08 / $398.11
| Professional | | $323.59 | $363.08 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,318.26 / $2,344.23
| Facility | | $213.80 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $263.03 / $478.63
| Professional | | $173.78 | $263.03 | $478.63 |