- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $4,786.30 / $7,943.28
| Facility | | $162.18 | $4,786.30 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $478.63 / $2,344.23
| Professional | | $190.55 | $478.63 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $562.34
| Professional | | $281.84 | $446.68 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $309.03 / $2,691.53
| Professional | | $194.98 | $309.03 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $478.63 / $2,137.96
| Facility | | $288.40 | $478.63 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | 62 | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | AS | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $407.38 / $3,630.78
| Professional | | $208.93 | $407.38 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $489.78 / $562.34
| Professional | | $436.52 | $489.78 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $562.34
| Professional | | $407.38 | $407.38 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $489.78
| Professional | | $204.17 | $346.74 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,819.70 / $3,388.44
| Facility | | $1,202.26 | $1,819.70 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $616.60
| Professional | | $194.98 | $302.00 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $407.38 / $478.63
| Professional | | $323.59 | $407.38 | $478.63 |