- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $3,548.13 / $7,079.46
| Facility | | $316.23 | $3,548.13 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $302.00 / $1,949.84
| Professional | | $87.10 | $302.00 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $354.81 / $4,265.80
| Facility | | $229.09 | $354.81 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $1,318.26 / $1,737.80
| Professional | | $147.91 | $1,318.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $245.47 / $2,187.76 / $2,630.27
| Professional | 50 | $245.47 | $2,187.76 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $25.12 / $27.54 / $275.42
| Professional | 80 | $25.12 | $27.54 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $21.38 / $23.44 / $234.42
| Professional | AS | $21.38 | $23.44 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $1,023.29 / $2,290.87
| Professional | | $109.65 | $1,023.29 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,818.38 / $2,818.38
| Professional | | $2,691.53 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $933.25 / $3,090.30
| Facility | | $97.72 | $933.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $316.23 / $2,137.96
| Professional | | $100.00 | $316.23 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $354.81 / $575.44
| Professional | | $32.36 | $354.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $2,041.74
| Professional | | $147.91 | $213.80 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $831.76 / $1,905.46
| Professional | | $100.00 | $831.76 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $8,317.64 / $9,332.54
| Facility | | $1,819.70 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $758.58 / $2,290.87
| Professional | | $102.33 | $758.58 | $2,290.87 |