- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $5,011.87 / $8,912.51
| Facility | | $2,089.30 | $5,011.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $1,148.15
| Professional | | $190.55 | $363.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $288.40 / $436.52
| Professional | | $204.17 | $288.40 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $7,943.28
| Facility | | $3,019.95 | $3,019.95 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $549.54
| Professional | | $223.87 | $354.81 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $295.12 / $416.87
| Facility | | $251.19 | $295.12 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $251.19 / $295.12
| Professional | | $194.98 | $251.19 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $7,585.78 / $58,884.37
| Facility | | $3,090.30 | $7,585.78 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $346.74 / $630.96
| Professional | | $234.42 | $346.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $1,047.13
| Professional | | $204.17 | $281.84 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Professional | 22 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 62
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | 62 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Professional | 80 | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $9.77
| Professional | AS | $9.77 | $9.77 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $389.05
| Professional | | $363.08 | $363.08 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,348.96 / $2,511.89
| Facility | | $354.81 | $1,348.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $288.40 / $489.78
| Professional | | $181.97 | $288.40 | $489.78 |