- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $1,737.80 / $8,709.64
| Facility | | $52.48 | $1,737.80 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $398.11 / $6,606.93
| Professional | | $151.36 | $398.11 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $331.13
| Facility | | $162.18 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $331.13 / $346.74
| Professional | | $162.18 | $331.13 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $380.19 / $478.63
| Professional | | $338.84 | $380.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $1,230.27
| Facility | | $199.53 | $288.40 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $398.11 / $5,128.61
| Professional | | $154.88 | $398.11 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $398.11 / $398.11
| Professional | | $363.08 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $380.19
| Professional | | $363.08 | $363.08 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $758.58
| Professional | | $218.78 | $309.03 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | 80 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | AS | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $316.23 / $645.65
| Professional | | $199.53 | $316.23 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $407.38 / $407.38
| Professional | | $331.13 | $407.38 | $407.38 |