- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $4,570.88 / $14,125.38
| Facility | | $758.58 | $4,570.88 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $457.09 / $1,548.82
| Professional | | $239.88 | $457.09 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $30.20 / $63.10 / $128.82
| Professional | AS | $30.20 | $63.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $457.09
| Professional | | $234.42 | $338.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $31.62 / $50.12 / $72.44
| Professional | AS | $31.62 | $50.12 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $21,379.62 / $26,915.35
| Facility | | $8,128.31 | $21,379.62 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $416.87 / $562.34
| Professional | | $269.15 | $416.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $79.43
| Professional | AS | $37.15 | $58.88 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $354.81 / $512.86
| Facility | | $309.03 | $354.81 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $309.03 / $354.81
| Professional | | $239.88 | $309.03 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $426.58 / $660.69
| Professional | | $288.40 | $426.58 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $1,412.54
| Professional | | $251.19 | $331.13 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Professional | 22 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 62
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | 62 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Professional | 80 | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.23
| Professional | AS | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $457.09 / $457.09
| Professional | | $446.68 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,348.96 / $2,344.23
| Facility | | $213.80 | $1,348.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $371.54 / $575.44
| Professional | | $229.09 | $371.54 | $575.44 |