- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $2,630.27 / $8,511.38
| Facility | | $426.58 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $891.25
| Professional | | $354.81 | $467.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $478.63
| Professional | | $257.04 | $257.04 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,398.83 / $4,365.16
| Facility | | $1,479.11 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $416.87 / $524.81
| Professional | | $346.74 | $416.87 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $512.86 / $660.69
| Facility | | $363.08 | $512.86 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $512.86 / $616.60
| Professional | | $380.19 | $512.86 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $691.83 / $691.83
| Facility | | $34.67 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Facility | AS | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $630.96 / $1,995.26
| Professional | | $407.38 | $630.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $302.00
| Professional | | $32.36 | $33.11 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,388.44 / $6,025.60
| Facility | | $602.56 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $489.78 / $794.33
| Professional | | $346.74 | $489.78 | $794.33 |