- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,454.71 / $6,918.31
| Facility | | $575.44 | $2,454.71 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $537.03 / $933.25
| Professional | | $457.09 | $537.03 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $354.81
| Facility | | $269.15 | $316.23 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $588.84 / $812.83
| Professional | | $467.74 | $588.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $478.63 / $478.63
| Facility | | $79.43 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- 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
- $489.78 / $676.08 / $1,071.52
| Professional | | $489.78 | $676.08 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $19,498.45 / $19,498.45
| Facility | | $3,162.28 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | 54 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,570.88 / $4,570.88
| Professional | | $3,890.45 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $691.83 / $2,290.87
| Facility | | $501.19 | $691.83 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $1,096.48
| Professional | | $467.74 | $691.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $407.38 / $489.78
| Professional | | $32.36 | $407.38 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,819.70 / $2,187.76
| Professional | | $602.56 | $1,819.70 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $660.69 / $1,096.48
| Facility | | $489.78 | $660.69 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Facility | 54 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $676.08 / $1,047.13
| Professional | | $489.78 | $676.08 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $851.14 / $2,290.87
| Facility | | $173.78 | $851.14 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $831.76
| Professional | | $407.38 | $537.03 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $575.44 / $602.56
| Professional | | $562.34 | $575.44 | $602.56 |