- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,380.38 / $5,623.41
| Facility | | $194.98 | $1,380.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $275.42 / $575.44
| Professional | | $190.55 | $275.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $141.25 / $295.12 / $407.38
| Professional | 54 | $141.25 | $295.12 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $281.84 / $331.13
| Professional | | $208.93 | $281.84 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,466.84 / $8,709.64
| Facility | | $2,454.71 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $346.74
| Professional | | $154.88 | $194.98 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $239.88 / $269.15
| Facility | | $190.55 | $239.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $263.03 / $288.40
| Professional | | $199.53 | $263.03 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $204.17
| Facility | | $173.78 | $173.78 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $251.19 / $436.52
| Professional | | $199.53 | $251.19 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $2,137.96 / $7,413.10
| Facility | | $208.93 | $2,137.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $218.78 / $380.19
| Professional | | $169.82 | $218.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | 54 | $87.10 | $87.10 | $87.10 |