- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $870.96 / $12,589.25
| Facility | | $134.90 | $870.96 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | AS | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $181.97 / $691.83
| Professional | | $89.13 | $181.97 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $141.25 / $204.17
| Professional | | $87.10 | $141.25 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,071.52 / $2,137.96
| Facility | | $776.25 | $1,071.52 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $257.04
| Professional | | $100.00 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $186.21 / $309.03
| Professional | | $100.00 | $186.21 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $208.93 / $371.54
| Facility | | $128.82 | $208.93 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $316.23
| Professional | | $128.82 | $199.53 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $213.80 / $302.00
| Facility | | $134.90 | $213.80 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $275.42
| Professional | | $100.00 | $154.88 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,096.48 / $2,137.96
| Facility | | $724.44 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $154.88 / $239.88
| Professional | | $102.33 | $154.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,513.56 / $3,019.95
| Facility | | $407.38 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $275.42
| Professional | | $100.00 | $158.49 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $125.89 / $165.96
| Professional | | $66.07 | $125.89 | $165.96 |