- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $2,344.23 / $5,623.41
| Facility | | $199.53 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $144.54 / $323.59
| Professional | | $107.15 | $144.54 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $74.13 / $165.96 / $288.40
| Professional | 54 | $74.13 | $165.96 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $123.03 / $181.97
| Professional | | $114.82 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $77.62 / $117.49 / $199.53
| Professional | 54 | $77.62 | $117.49 | $199.53 |
- 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
- $91.20 / $114.82 / $186.21
| Professional | | $91.20 | $114.82 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $125.89 / $141.25
| Facility | | $114.82 | $125.89 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $141.25 / $239.88
| Professional | | $114.82 | $141.25 | $239.88 |
- 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
- $97.72 / $125.89 / $218.78
| Professional | | $97.72 | $125.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | 54 | $87.10 | $87.10 | $87.10 |