- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $4,365.16 / $8,128.31
| Facility | | $676.08 | $4,365.16 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $575.44 / $1,258.93
| Professional | | $389.05 | $575.44 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $575.44 / $691.83
| Professional | | $177.83 | $575.44 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,698.24 / $1,737.80
| Facility | | $1,698.24 | $1,698.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $691.83 / $1,230.27
| Professional | | $501.19 | $691.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $2,818.38
| Facility | | $524.81 | $524.81 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $616.60 / $933.25
| Professional | | $426.58 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $977.24
| Professional | | $741.31 | $741.31 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $933.25
| Facility | | $416.87 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $758.58 / $933.25
| Professional | | $588.84 | $758.58 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $6,760.83 / $10,715.19
| Facility | | $2,344.23 | $6,760.83 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $489.78 / $891.25
| Professional | | $363.08 | $489.78 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $9,332.54 / $28,840.32
| Facility | | $9,332.54 | $9,332.54 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | 52 | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Facility | AS | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,388.44 / $3,548.13
| Professional | | $3,388.44 | $3,388.44 | $3,548.13 |