- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $3,162.28 / $7,585.78
| Facility | | $537.03 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $794.33
| Professional | | $229.09 | $380.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $15.49 / $42.66 / $107.15
| Professional | AS | $15.49 | $42.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $234.42 / $316.23
| Professional | | $190.55 | $234.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $42.66
| Professional | AS | $28.84 | $34.67 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $346.74 / $549.54
| Professional | | $275.42 | $346.74 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $389.05 / $1,905.46
| Facility | | $251.19 | $389.05 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $354.81 / $1,819.70
| Professional | | $263.03 | $354.81 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | AS | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $537.03 / $3,090.30
| Facility | | $190.55 | $537.03 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $436.52
| Professional | | $245.47 | $323.59 | $436.52 |