- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,511.89 / $6,918.31
| Facility | | $575.44 | $2,511.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $3,890.45 / $8,511.38
| Facility | | $1,023.29 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,187.76 / $2,511.89
| Facility | | $1,023.29 | $2,187.76 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $199.53
| Facility | | $109.65 | $109.65 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $3,630.78 / $6,918.31
| Facility | | $389.05 | $3,630.78 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | 62 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Facility | AS | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $5,011.87 / $5,011.87
| Facility | | $1,174.90 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | 62 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | AS | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $426.58 / $4,073.80
| Facility | | $194.98 | $426.58 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $245.47 / $416.87
| Facility | | $177.83 | $245.47 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | 62 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | AS | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $954.99 / $4,570.88
| Facility | | $162.18 | $954.99 | $4,570.88 |