- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $8,128.31 / $14,791.08
| Facility | | $1,412.54 | $8,128.31 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $346.74 / $891.25
| Professional | | $181.97 | $346.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $380.19
| Facility | | $223.87 | $269.15 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $426.58 / $501.19
| Professional | | $213.80 | $426.58 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $354.81 / $354.81
| Facility | | $34.67 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | 22 | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | 62 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Facility | AS | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $1,288.25
| Professional | | $199.53 | $338.84 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $7,585.78 / $13,489.63
| Facility | | $3,981.07 | $7,585.78 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $251.19 / $371.54
| Professional | | $165.96 | $251.19 | $371.54 |