- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $2,187.76 / $6,456.54
| Facility | | $467.74 | $2,187.76 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,380.38 / $9,772.37
| Facility | | $776.25 | $1,380.38 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,041.74 / $5,128.61
| Facility | | $398.11 | $2,041.74 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $630.96
| Facility | | $426.58 | $426.58 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | 62 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $6,456.54 / $6,456.54
| Facility | | $5,623.41 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 62 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | AS | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,071.52 / $3,890.45
| Facility | | $645.65 | $1,071.52 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $977.24 / $1,698.24
| Facility | | $660.69 | $977.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 62 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | AS | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $7,413.10 / $17,782.79
| Facility | | $2,630.27 | $7,413.10 | $17,782.79 |