- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $2,570.40 / $7,413.10
| Facility | | $147.91 | $2,570.40 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $346.74
| Professional | | $104.71 | $162.18 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $114.82 / $204.17 / $323.59
| Professional | 54 | $114.82 | $204.17 | $323.59 |
- 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
- $102.33 / $134.90 / $208.93
| Professional | | $102.33 | $134.90 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $144.54 / $194.98
| Professional | | $125.89 | $144.54 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $158.49 / $251.19
| Professional | | $123.03 | $158.49 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $812.83
| Facility | | $89.13 | $165.96 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $229.09 / $398.11 / $398.11
| Facility | 54 | $229.09 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $177.83 / $933.25
| Professional | | $114.82 | $177.83 | $933.25 |
- 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
- $104.71 / $138.04 / $218.78
| Professional | | $104.71 | $138.04 | $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 |