- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $2,290.87 / $6,165.95
| Facility | | $630.96 | $2,290.87 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $446.68 / $2,570.40
| Professional | | $89.13 | $446.68 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $77.62 / $977.24
| Professional | | $72.44 | $77.62 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $870.96 / $1,659.59
| Facility | | $204.17 | $870.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $1,258.93
| Professional | | $87.10 | $151.36 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Facility | 62 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $389.05 / $2,041.74
| Professional | | $93.33 | $389.05 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $912.01 / $1,905.46
| Facility | | $91.20 | $912.01 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $5,128.61
| Facility | 62 | $245.47 | $245.47 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,778.28 / $6,760.83
| Professional | | $1,174.90 | $1,778.28 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,122.02 / $2,137.96
| Facility | | $660.69 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $812.83 / $1,949.84
| Professional | | $89.13 | $812.83 | $1,949.84 |