- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $2,511.89 / $6,760.83
| Facility | | $199.53 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $165.96 / $407.38
| Professional | | $120.23 | $165.96 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $323.59 / $436.52
| Professional | | $144.54 | $323.59 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $416.87
| Professional | | $117.49 | $186.21 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $323.59 / $1,148.15
| Facility | | $158.49 | $323.59 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Facility | 54 | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $288.40 / $977.24
| Professional | | $144.54 | $288.40 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $323.59 / $389.05
| Professional | | $281.84 | $323.59 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $288.40 / $389.05
| Professional | | $239.88 | $288.40 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $323.59
| Professional | | $131.83 | $239.88 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $758.58 / $2,344.23
| Facility | | $371.54 | $758.58 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $371.54
| Professional | | $117.49 | $181.97 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $288.40 / $338.84
| Professional | | $223.87 | $288.40 | $338.84 |