- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $2,818.38 / $7,762.47
| Facility | | $645.65 | $2,818.38 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $575.44 / $1,318.26
| Professional | | $457.09 | $575.44 | $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
- $407.38 / $524.81 / $1,288.25
| Professional | | $407.38 | $524.81 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,258.93 / $4,073.80
| Facility | | $707.95 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $741.31
| Professional | | $707.95 | $707.95 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,318.26 / $50,118.72
| Facility | | $851.14 | $1,318.26 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | 54 | $602.56 | $602.56 | $602.56 |
- 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
- $588.84 / $794.33 / $1,905.46
| Facility | | $588.84 | $794.33 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $933.25 / $1,348.96
| Professional | | $630.96 | $933.25 | $1,348.96 |
- 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
- $398.11 / $398.11 / $398.11
| Facility | 54 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $707.95 / $1,122.02
| Professional | | $436.52 | $707.95 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $1,318.26
| Professional | | $741.31 | $741.31 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $50,118.72 / $75,857.76
| Facility | | $501.19 | $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
- $446.68 / $691.83 / $2,089.30
| Professional | | $446.68 | $691.83 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $602.56 / $2,137.96
| Facility | | $416.87 | $602.56 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $323.59 / $338.84 / $478.63
| Facility | 54 | $323.59 | $338.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $676.08 / $1,445.44
| Professional | | $436.52 | $676.08 | $1,445.44 |