- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $2,290.87 / $10,232.93
| Facility | | $199.53 | $2,290.87 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $269.15 / $3,981.07
| Professional | | $194.98 | $269.15 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $416.87
| Facility | | $204.17 | $239.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $478.63 / $602.56
| Professional | | $426.58 | $478.63 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $316.23 / $812.83
| Facility | | $194.98 | $316.23 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $407.38 / $1,584.89
| Professional | | $194.98 | $407.38 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $501.19 / $501.19
| Professional | | $457.09 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $446.68
| Professional | | $275.42 | $380.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Professional | 80 | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Professional | AS | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $575.44
| Professional | | $229.09 | $380.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $467.74
| Professional | | $380.19 | $380.19 | $467.74 |