- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $691.83 / $4,365.16
| Facility | | $316.23 | $691.83 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $575.44 / $912.01
| Professional | | $309.03 | $575.44 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $933.25 / $1,995.26
| Professional | | $676.08 | $933.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $831.76 / $1,380.38
| Facility | | $467.74 | $831.76 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,230.27 / $5,011.87
| Professional | | $562.34 | $1,230.27 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $1,380.38
| Professional | | $741.31 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $707.95 / $1,288.25
| Professional | | $676.08 | $707.95 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $933.25 / $1,318.26
| Professional | | $549.54 | $933.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | AS | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $758.58 / $1,621.81
| Professional | | $380.19 | $758.58 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $794.33 / $1,584.89
| Professional | | $645.65 | $794.33 | $1,584.89 |