- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $2,884.03 / $7,762.47
| Facility | | $630.96 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $562.34 / $1,318.26
| Professional | | $446.68 | $562.34 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $1,288.25
| Professional | | $436.52 | $549.54 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,258.93 / $4,073.80
| Facility | | $676.08 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $741.31
| Professional | | $676.08 | $676.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,318.26 / $50,118.72
| Facility | | $831.76 | $1,318.26 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | 54 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $776.25 / $2,089.30
| Professional | | $512.86 | $776.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $562.34 / $1,412.54
| Facility | | $346.74 | $562.34 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $933.25 / $1,318.26
| Professional | | $630.96 | $933.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 54 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $691.83 / $1,122.02
| Professional | | $426.58 | $691.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $50,118.72 / $75,857.76
| Facility | | $489.78 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $707.95 / $1,445.44
| Professional | | $398.11 | $707.95 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,398.83 / $4,897.79
| Facility | | $1,071.52 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $676.08 / $2,089.30
| Professional | | $436.52 | $676.08 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $2,089.30
| Facility | | $398.11 | $588.84 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $316.23 / $338.84 / $457.09
| Facility | 54 | $316.23 | $338.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $676.08 / $1,445.44
| Professional | | $436.52 | $676.08 | $1,445.44 |