- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $6,025.60 / $17,378.01
| Facility | | $954.99 | $6,025.60 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $588.84 / $2,137.96
| Professional | | $239.88 | $588.84 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $29.51 / $87.10 / $323.59
| Professional | AS | $29.51 | $87.10 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $354.81
| Professional | | $208.93 | $251.19 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $70.79
| Professional | AS | $28.84 | $34.67 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $8,128.31 / $15,848.93
| Facility | | $4,570.88 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $537.03 / $870.96
| Professional | | $398.11 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $32.36 / $41.69 / $93.33
| Professional | AS | $32.36 | $41.69 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $100.00
| Facility | | $77.62 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $707.95
| Professional | | $257.04 | $363.08 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $331.13 / $660.69
| Professional | | $257.04 | $331.13 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $234.42 / $316.23
| Professional | | $218.78 | $234.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $691.83
| Professional | | $204.17 | $269.15 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $5,011.87 / $5,011.87
| Facility | | $1,548.82 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Facility | 62 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,238.72 / $2,238.72
| Professional | | $1,778.28 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $512.86
| Facility | | $229.09 | $288.40 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $660.69
| Professional | | $257.04 | $338.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $371.54
| Professional | | $190.55 | $263.03 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,584.89 / $6,760.83
| Facility | | $588.84 | $1,584.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $616.60
| Professional | | $204.17 | $295.12 | $616.60 |