- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $2,884.03 / $7,762.47
| Facility | | $251.19 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | 62 | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $549.54 / $1,995.26
| Professional | | $251.19 | $549.54 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $30.90 / $69.18 / $213.80
| Professional | AS | $30.90 | $69.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $363.08 / $446.68
| Professional | | $288.40 | $363.08 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $69.18
| Professional | AS | $47.86 | $56.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $512.86 / $776.25
| Professional | | $309.03 | $512.86 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $630.96
| Professional | | $275.42 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $288.40 / $457.09
| Facility | | $251.19 | $288.40 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $478.63
| Professional | | $338.84 | $398.11 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $794.33 / $1,995.26
| Facility | | $295.12 | $794.33 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $537.03
| Professional | | $218.78 | $309.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $5,011.87
| Facility | | $1,548.82 | $1,548.82 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Facility | 62 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $2,238.72
| Professional | | $1,778.28 | $1,778.28 | $2,238.72 |