- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $537.03 / $4,897.79
| Facility | | $173.78 | $537.03 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $275.42 / $501.19
| Professional | | $186.21 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $257.04 / $407.38 / $933.25
| Professional | 54 | $257.04 | $407.38 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Professional | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $288.40 / $338.84
| Professional | | $223.87 | $288.40 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $363.08
| Facility | | $234.42 | $234.42 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $208.93 / $281.84
| Professional | | $199.53 | $208.93 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $251.19 / $380.19
| Professional | | $177.83 | $251.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $575.44 / $4,897.79
| Facility | | $223.87 | $575.44 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $467.74
| Professional | | $194.98 | $281.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $602.56
| Professional | 54 | $257.04 | $316.23 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $251.19 / $371.54
| Professional | | $162.18 | $251.19 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $724.44 / $1,698.24
| Facility | | $194.98 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $239.88 / $331.13
| Professional | | $190.55 | $239.88 | $331.13 |