- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $2,089.30 / $8,912.51
| Facility | | $426.58 | $2,089.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $446.68 / $1,318.26
| Professional | | $239.88 | $446.68 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $33.88 / $66.07 / $154.88
| Professional | AS | $33.88 | $66.07 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $239.88 / $346.74
| Professional | | $213.80 | $239.88 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $28.84 / $32.36 / $43.65
| Professional | AS | $28.84 | $32.36 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $489.78
| Professional | | $234.42 | $309.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $67.61
| Professional | AS | $33.11 | $43.65 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $275.42 / $407.38
| Professional | | $269.15 | $275.42 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $316.23 / $407.38
| Facility | | $251.19 | $316.23 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $309.03 / $588.84
| Professional | | $245.47 | $309.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $537.03
| Professional | | $245.47 | $363.08 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $2,630.27 / $5,011.87
| Facility | | $912.01 | $2,630.27 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $354.81 / $537.03
| Professional | | $229.09 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $10.72 / $10.96 / $41.69
| Professional | AS | $10.72 | $10.96 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $53.70
| Professional | | $32.36 | $33.11 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $512.86
| Professional | | $234.42 | $309.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Professional | AS | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,047.13 / $3,235.94
| Facility | | $478.63 | $1,047.13 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $309.03 / $478.63
| Professional | | $199.53 | $309.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Professional | AS | $83.18 | $83.18 | $83.18 |