- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $3,467.37 / $8,709.64
| Facility | | $263.03 | $3,467.37 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $478.63 / $1,737.80
| Professional | | $239.88 | $478.63 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $25.70 / $69.18 / $416.87
| Professional | AS | $25.70 | $69.18 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $467.74
| Professional | | $245.47 | $338.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $63.10
| Professional | AS | $32.36 | $40.74 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $6,309.57 / $12,302.69
| Facility | | $891.25 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $263.03 / $331.13
| Professional | | $199.53 | $263.03 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $436.52 / $436.52
| Facility | | $323.59 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Facility | 22 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | 62 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | AS | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $354.81 / $562.34
| Professional | | $229.09 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,884.03 / $6,760.83
| Facility | | $1,548.82 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $208.93 / $331.13
| Professional | | $165.96 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $380.19
| Professional | | $32.36 | $33.11 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,548.82 / $3,890.45
| Facility | | $331.13 | $1,548.82 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $549.54
| Professional | | $204.17 | $302.00 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $275.42
| Professional | | $199.53 | $199.53 | $275.42 |