- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $3,548.13 / $10,000.00
| Facility | | $933.25 | $3,548.13 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,122.02 / $3,235.94
| Professional | | $741.31 | $1,122.02 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $69.18 / $338.84 / $912.01
| Professional | AS | $69.18 | $338.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $8,317.64 / $16,218.10
| Facility | | $3,235.94 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,202.26 / $2,238.72
| Professional | | $851.14 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $120.23 / $165.96 / $302.00
| Professional | AS | $120.23 | $165.96 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $3,235.94 / $9,549.93
| Facility | | $1,023.29 | $3,235.94 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,288.25 / $2,691.53
| Professional | | $831.76 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $5,248.07 / $11,748.98
| Facility | | $2,089.30 | $5,248.07 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,122.02 / $2,137.96
| Professional | | $741.31 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $338.84
| Professional | AS | $257.04 | $257.04 | $338.84 |