- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $2,630.27 / $12,589.25
| Facility | | $407.38 | $2,630.27 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $316.23 / $575.44
| Professional | | $165.96 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $79.43 / $144.54
| Professional | | $75.86 | $79.43 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $9,332.54 / $14,791.08
| Facility | | $5,888.44 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $380.19 / $524.81
| Professional | | $177.83 | $380.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $338.84 / $660.69
| Professional | | $144.54 | $338.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $575.44 / $6,025.60
| Facility | | $199.53 | $575.44 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Facility | AS | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $2,951.21
| Professional | | $338.84 | $501.19 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $4,073.80 / $9,120.11
| Facility | | $1,230.27 | $4,073.80 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $338.84 / $616.60
| Professional | | $162.18 | $338.84 | $616.60 |