- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,659.59 / $8,128.31
| Facility | | $831.76 | $1,659.59 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $2,511.89
| Professional | | $724.44 | $1,023.29 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $54.95 / $169.82 / $169.82
| Professional | AS | $54.95 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,737.80 / $4,168.69
| Facility | | $851.14 | $1,737.80 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,511.89 / $3,162.28
| Professional | | $1,778.28 | $2,511.89 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,412.54 / $2,818.38
| Facility | | $1,000.00 | $1,412.54 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,137.96 / $7,943.28
| Professional | | $954.99 | $2,137.96 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,995.26 / $2,454.71
| Professional | | $1,905.46 | $1,995.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $2,238.72
| Professional | | $1,819.70 | $1,819.70 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,778.28 / $2,089.30
| Professional | | $1,318.26 | $1,778.28 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Professional | 80 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Professional | AS | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,698.24 / $2,754.23
| Professional | | $954.99 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,905.46 / $2,344.23
| Professional | | $1,548.82 | $1,905.46 | $2,344.23 |