- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $302.00 / $14,454.40
| Facility | | $162.18 | $302.00 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,882.50 / $18,197.01 / $29,512.09
| Facility | | $12,882.50 | $18,197.01 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $436.52 / $707.95
| Facility | | $371.54 | $436.52 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Facility | AS | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $9,332.54
| Facility | | $154.88 | $213.80 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $6,165.95
| Facility | | $154.88 | $213.80 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | AS | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $302.00
| Facility | | $218.78 | $218.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $331.13 / $512.86
| Professional | | $186.21 | $331.13 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $954.99
| Facility | | $269.15 | $380.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $95.50
| Facility | AS | $26.92 | $38.02 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $6,760.83 / $19,498.45
| Facility | | $1,995.26 | $6,760.83 | $19,498.45 |