- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,089.30 / $4,677.35
| Facility | | $489.78 | $2,089.30 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $489.78 / $1,023.29
| Professional | | $323.59 | $489.78 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,630.27 / $7,762.47
| Facility | | $56.23 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | AS | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $630.96 / $1,445.44
| Professional | | $371.54 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $912.01
| Facility | | $398.11 | $398.11 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $676.08 / $1,047.13
| Professional | | $398.11 | $676.08 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $645.65 / $1,288.25
| Professional | | $354.81 | $645.65 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $457.09 / $3,311.31
| Facility | | $323.59 | $457.09 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $660.69 / $933.25
| Professional | | $537.03 | $660.69 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,265.80 / $9,772.37
| Facility | | $2,041.74 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $660.69 / $1,230.27
| Professional | | $380.19 | $660.69 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $4,466.84 / $5,370.32
| Facility | | $3,019.95 | $4,466.84 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $512.86 / $549.54
| Professional | | $181.97 | $512.86 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,630.27 / $7,762.47
| Facility | | $56.23 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | AS | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $630.96 / $1,445.44
| Professional | | $371.54 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,981.07 / $9,549.93
| Facility | | $1,862.09 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $660.69 / $1,318.26
| Professional | | $380.19 | $660.69 | $1,318.26 |