- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $3,090.30 / $10,964.78
| Facility | | $0.79 | $3,090.30 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $158.49 / $316.23
| Professional | | $128.82 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $194.98 / $263.03
| Professional | | $138.04 | $194.98 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $6,309.57 / $12,302.69
| Facility | | $891.25 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $177.83
| Professional | | $109.65 | $151.36 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $323.59
| Facility | | $245.47 | $245.47 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | AS | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $309.03
| Professional | | $123.03 | $190.55 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,884.03 / $6,760.83
| Facility | | $1,348.96 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $107.15 / $165.96
| Professional | | $87.10 | $107.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $173.78
| Professional | | $32.36 | $33.11 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,548.82 / $3,890.45
| Facility | | $331.13 | $1,548.82 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $158.49 / $295.12
| Professional | | $109.65 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $154.88
| Professional | | $109.65 | $109.65 | $154.88 |