- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,288.25 / $3,890.45
| Facility | | $398.11 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $416.87 / $1,000.00
| Professional | | $239.88 | $416.87 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $33.88 / $67.61 / $151.36
| Professional | AS | $33.88 | $67.61 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $281.84 / $363.08
| Professional | | $245.47 | $281.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $38.02 / $40.74 / $47.86
| Professional | AS | $38.02 | $40.74 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $776.25 / $2,041.74
| Facility | | $0.02 | $776.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $346.74 / $416.87
| Professional | | $281.84 | $346.74 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $512.86
| Professional | | $275.42 | $380.19 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $562.34 / $1,318.26
| Facility | | $218.78 | $562.34 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $295.12 / $489.78
| Professional | | $229.09 | $295.12 | $489.78 |