- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,905.46 / $3,715.35
| Facility | | $416.87 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $380.19 / $2,290.87
| Professional | | $89.13 | $380.19 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,122.02 / $8,128.31
| Facility | | $56.23 | $1,122.02 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | 62 | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $933.25 / $3,019.95
| Professional | | $93.33 | $933.25 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $229.09
| Facility | | $97.72 | $97.72 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $239.88 / $2,089.30
| Professional | | $97.72 | $239.88 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $13.18 / $19.95 / $32.36
| Professional | AS | $13.18 | $19.95 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $269.15 / $2,454.71
| Professional | | $104.71 | $269.15 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $114.82 / $3,311.31
| Facility | | $77.62 | $114.82 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,318.26 / $2,137.96
| Professional | | $954.99 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $398.11 / $2,238.72
| Professional | | $95.50 | $398.11 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $2,454.71
| Facility | | $562.34 | $562.34 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $1,348.96
| Professional | | $173.78 | $281.84 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,122.02 / $8,128.31
| Facility | | $56.23 | $1,122.02 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | 62 | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $933.25 / $3,019.95
| Professional | | $93.33 | $933.25 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,862.09 / $2,818.38
| Facility | | $741.31 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $1,000.00 / $2,511.89
| Professional | | $97.72 | $1,000.00 | $2,511.89 |