- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,548.82 / $4,677.35
| Facility | | $851.14 | $1,548.82 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $1,949.84
| Professional | | $758.58 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | AS | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,073.80 / $8,912.51
| Facility | | $2,454.71 | $4,073.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $912.01 / $1,202.26
| Professional | | $741.31 | $912.01 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $104.71 / $125.89 / $165.96
| Professional | AS | $104.71 | $125.89 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,023.29 / $1,202.26
| Facility | | $776.25 | $1,023.29 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,122.02 / $1,548.82
| Professional | | $912.01 | $1,122.02 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $1,479.11 / $1,698.24
| Facility | | $34.67 | $1,479.11 | $1,698.24 |
- 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
- $812.83 / $1,202.26 / $5,128.61
| Professional | | $812.83 | $1,202.26 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,890.45 / $8,511.38
| Facility | | $1,000.00 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $1,659.59
| Professional | | $794.33 | $1,071.52 | $1,659.59 |