- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $2,041.74 / $4,897.79
| Facility | | $295.12 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $512.86 / $2,089.30
| Professional | | $245.47 | $512.86 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $34.67 / $70.79 / $213.80
| Professional | AS | $34.67 | $70.79 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $380.19
| Professional | | $223.87 | $354.81 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | AS | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $389.05 / $416.87
| Professional | | $239.88 | $389.05 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $354.81 / $549.54
| Facility | | $295.12 | $354.81 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $616.60
| Professional | | $239.88 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $316.23 / $501.19
| Professional | | $213.80 | $316.23 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,995.26 / $4,897.79
| Facility | | $295.12 | $1,995.26 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $933.25
| Professional | | $245.47 | $346.74 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $33.88 / $67.61 / $165.96
| Professional | AS | $33.88 | $67.61 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $398.11
| Professional | | $208.93 | $316.23 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,258.93 / $2,454.71
| Facility | | $467.74 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $331.13 / $446.68
| Professional | | $245.47 | $331.13 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Professional | AS | $83.18 | $83.18 | $83.18 |