- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $2,691.53 / $7,413.10
| Facility | | $645.65 | $2,691.53 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $602.56 / $1,258.93
| Professional | | $457.09 | $602.56 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $10,232.93
| Facility | | $2,630.27 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $1,318.26
| Professional | | $436.52 | $549.54 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,258.93 / $4,073.80
| Facility | | $691.83 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $758.58
| Professional | | $691.83 | $691.83 | $758.58 |
- 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
- $588.84 / $588.84 / $588.84
| Facility | 54 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $794.33 / $2,137.96
| Professional | | $512.86 | $794.33 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $1,949.84
| Facility | | $537.03 | $776.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $977.24 / $1,412.54
| Professional | | $660.69 | $977.24 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | 54 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $724.44 / $1,148.15
| Professional | | $446.68 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,089.30 / $2,630.27
| Facility | | $2,041.74 | $2,089.30 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $1,318.26
| Professional | | $691.83 | $977.24 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $50,118.72 / $75,857.76
| Facility | | $512.86 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $707.95 / $1,479.11
| Professional | | $398.11 | $707.95 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,467.37 / $7,244.36
| Facility | | $1,862.09 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $691.83 / $2,137.96
| Professional | | $457.09 | $691.83 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $2,187.76
| Facility | | $407.38 | $602.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $323.59 / $346.74 / $467.74
| Facility | 54 | $323.59 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $691.83 / $1,479.11
| Professional | | $446.68 | $691.83 | $1,479.11 |