- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,041.74 / $6,918.31
| Facility | | $524.81 | $2,041.74 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,174.90 / $6,918.31
| Facility | | $812.83 | $1,174.90 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,041.74 / $5,011.87
| Facility | | $724.44 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $707.95 / $707.95
| Facility | | $645.65 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | 22 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 62 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,495.41 / $6,760.83
| Facility | | $5,495.41 | $5,495.41 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | 62 | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | AS | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,096.48 / $3,801.89
| Facility | | $660.69 | $1,096.48 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,000.00 / $1,778.28
| Facility | | $691.83 | $1,000.00 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 22 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Facility | 62 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | AS | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $954.99 / $2,398.83
| Facility | | $162.18 | $954.99 | $2,398.83 |