- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,819.70 / $5,754.40
| Facility | | $213.80 | $1,819.70 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $302.00 / $575.44
| Professional | | $186.21 | $302.00 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $204.17 / $426.58 / $933.25
| Professional | 54 | $204.17 | $426.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $346.74
| Professional | | $177.83 | $234.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $257.04 / $346.74
| Professional | | $213.80 | $257.04 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $275.42 / $446.68
| Professional | | $199.53 | $275.42 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $288.40 / $870.96
| Facility | | $154.88 | $288.40 | $870.96 |
- 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
- $208.93 / $338.84 / $1,659.59
| Professional | | $208.93 | $338.84 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $549.54 / $1,584.89
| Facility | | $194.98 | $549.54 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $239.88 / $380.19
| Professional | | $181.97 | $239.88 | $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 |