- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $6,025.60 / $13,182.57
| Facility | | $407.38 | $6,025.60 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $467.74 / $1,778.28
| Professional | | $199.53 | $467.74 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $363.08 / $426.58
| Professional | | $331.13 | $363.08 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $8,709.64 / $16,982.44
| Facility | | $6,606.93 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $295.12 / $398.11
| Professional | | $173.78 | $295.12 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $446.68 / $645.65
| Professional | | $363.08 | $446.68 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $331.13 / $4,365.16
| Facility | | $181.97 | $331.13 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $316.23 / $602.56 / $602.56
| Facility | 62 | $316.23 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $50.12 / $95.50 / $95.50
| Facility | AS | $50.12 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $3,630.78
| Professional | | $229.09 | $380.19 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $467.74 / $645.65
| Professional | | $380.19 | $467.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $426.58 / $645.65
| Professional | | $380.19 | $426.58 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,548.82 / $4,466.84
| Facility | | $1,096.48 | $1,548.82 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $562.34
| Professional | | $245.47 | $363.08 | $562.34 |