- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,454.71 / $7,585.78
| Facility | | $575.44 | $2,454.71 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,479.11 / $6,760.83
| Facility | | $851.14 | $1,479.11 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $707.95 / $741.31
| Facility | | $79.43 | $707.95 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $870.96
| Facility | 62 | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $5,011.87 / $5,011.87
| Facility | | $4,897.79 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | 62 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Facility | AS | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,148.15 / $3,715.35
| Facility | | $724.44 | $1,148.15 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,071.52 / $1,862.09
| Facility | | $741.31 | $1,071.52 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | 62 | $812.83 | $812.83 | $812.83 |
- 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
- $162.18 / $954.99 / $3,162.28
| Facility | | $162.18 | $954.99 | $3,162.28 |