- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $2,398.83 / $7,413.10
| Facility | | $338.84 | $2,398.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $562.34 / $1,778.28
| Professional | | $245.47 | $562.34 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $23.99 / $64.57 / $213.80
| Professional | AS | $23.99 | $64.57 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $346.74
| Professional | | $190.55 | $263.03 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | AS | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $7,244.36 / $14,454.40
| Facility | | $2,238.72 | $7,244.36 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $338.84 / $501.19
| Professional | | $269.15 | $338.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $70.79
| Professional | AS | $37.15 | $47.86 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $281.84 / $380.19
| Professional | | $234.42 | $281.84 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $16,218.10 / $16,218.10
| Facility | | $13,182.57 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $575.44
| Professional | | $263.03 | $363.08 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $5,011.87
| Facility | | $239.88 | $407.38 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $389.05 / $724.44 / $724.44
| Facility | 62 | $389.05 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $61.66 / $117.49 / $117.49
| Facility | AS | $61.66 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $1,819.70
| Professional | | $245.47 | $363.08 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $707.95 / $9,549.93
| Facility | | $338.84 | $707.95 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $489.78
| Professional | | $229.09 | $316.23 | $489.78 |