- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $3,715.35 / $7,413.10
| Facility | | $794.33 | $3,715.35 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,148.15 / $2,344.23
| Professional | | $758.58 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $134.90 / $338.84 / $645.65
| Professional | AS | $134.90 | $338.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,174.90 / $1,995.26
| Professional | | $758.58 | $1,174.90 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $125.89
| Professional | AS | $102.33 | $102.33 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $3,801.89 / $6,760.83
| Facility | | $1,230.27 | $3,801.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,174.90 / $1,862.09
| Professional | | $891.25 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $125.89 / $165.96 / $263.03
| Professional | AS | $125.89 | $165.96 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,230.27 / $3,235.94
| Facility | | $977.24 | $1,230.27 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,071.52 / $1,174.90
| Professional | | $1,000.00 | $1,071.52 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,174.90 / $2,089.30
| Professional | | $724.44 | $1,174.90 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,258.93 / $3,801.89
| Professional | | $870.96 | $1,258.93 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $57.54
| Professional | 80 | $45.71 | $45.71 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $28.84
| Professional | AS | $22.91 | $22.91 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,380.38 / $1,584.89
| Professional | | $1,096.48 | $1,380.38 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $5,370.32 / $8,511.38
| Facility | | $1,513.56 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,288.25 / $2,290.87
| Professional | | $851.14 | $1,288.25 | $2,290.87 |