- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $229.09 / $645.65
| Facility | | $213.80 | $229.09 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $512.86
| Professional | | $186.21 | $263.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $331.13 / $933.25 / $1,380.38
| Professional | 54 | $331.13 | $933.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $812.83 / $2,290.87
| Facility | | $323.59 | $812.83 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $537.03 / $812.83
| Professional | | $354.81 | $537.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $660.69
| Professional | 54 | $288.40 | $436.52 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $851.14 / $1,995.26
| Facility | | $588.84 | $851.14 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $676.08 / $1,000.00
| Professional | | $407.38 | $676.08 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $812.83 / $1,584.89
| Facility | | $645.65 | $812.83 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $575.44 / $912.01
| Professional | | $398.11 | $575.44 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $398.11 / $691.83
| Facility | | $213.80 | $398.11 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Facility | 54 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $478.63 / $1,584.89
| Professional | | $223.87 | $478.63 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,778.28 / $3,715.35
| Facility | | $616.60 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $436.52 / $831.76
| Professional | | $204.17 | $436.52 | $831.76 |