- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,412.54 / $6,918.31
| Facility | | $363.08 | $1,412.54 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $512.86 / $2,454.71
| Professional | | $239.88 | $512.86 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $30.90 / $147.91 / $575.44
| Professional | AS | $30.90 | $147.91 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,630.78 / $4,365.16
| Facility | | $1,584.89 | $3,630.78 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $478.63 / $489.78
| Professional | | $407.38 | $478.63 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $54.95 / $63.10 / $66.07
| Professional | AS | $54.95 | $63.10 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $354.81 / $446.68
| Professional | | $269.15 | $354.81 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $407.38 / $6,309.57
| Facility | | $234.42 | $407.38 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $426.58 / $676.08
| Professional | | $309.03 | $426.58 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $30.90 / $85.11 / $575.44
| Professional | AS | $30.90 | $85.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $512.86 / $537.03
| Professional | | $416.87 | $512.86 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $223.87 / $630.96
| Professional | | $199.53 | $223.87 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $537.03
| Professional | | $269.15 | $380.19 | $537.03 |