- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $1,621.81 / $5,623.41
| Facility | | $0.60 | $1,621.81 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $501.19 / $4,677.35
| Professional | | $194.98 | $501.19 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $234.42 / $275.42
| Professional | | $218.78 | $234.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $2,454.71 / $4,677.35
| Facility | | $933.25 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $380.19
| Professional | | $234.42 | $309.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | 22 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 52 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | AS | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $302.00 / $446.68
| Professional | | $218.78 | $302.00 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $363.08 / $1,230.27
| Professional | | $208.93 | $363.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $275.42 / $302.00
| Professional | | $245.47 | $275.42 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $851.14 / $2,290.87
| Facility | | $173.78 | $851.14 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $275.42 / $457.09
| Professional | | $194.98 | $275.42 | $457.09 |