- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $269.15 / $14,454.40
| Facility | | $147.91 | $269.15 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,128.31 / $13,803.84
| Facility | | $5,011.87 | $8,128.31 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $630.96
| Facility | | $338.84 | $398.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $23.99
| Facility | AS | $23.99 | $23.99 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $208.93 / $8,912.51
| Facility | | $138.04 | $208.93 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $218.78 / $5,888.44
| Facility | | $138.04 | $218.78 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Facility | AS | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $275.42
| Facility | | $199.53 | $199.53 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $295.12 / $457.09
| Professional | | $165.96 | $295.12 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,288.25 / $1,288.25
| Facility | | $239.88 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $87.10
| Facility | AS | $23.99 | $33.88 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- 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 |