- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $977.24 / $6,606.93
| Facility | | $177.83 | $977.24 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $331.13 / $2,691.53
| Professional | | $109.65 | $331.13 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Facility | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $549.54 / $1,122.02
| Professional | | $407.38 | $549.54 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $501.19 / $1,000.00
| Facility | | $251.19 | $501.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $891.25 / $2,951.21
| Professional | | $389.05 | $891.25 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $426.58 / $933.25
| Professional | | $398.11 | $426.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $416.87 / $933.25
| Professional | | $389.05 | $416.87 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $562.34 / $741.31
| Professional | | $295.12 | $562.34 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Professional | 80 | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Professional | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $14,791.08
| Facility | | $3,162.28 | $3,162.28 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $489.78 / $1,047.13
| Professional | | $234.42 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $426.58 / $891.25
| Professional | | $346.74 | $426.58 | $891.25 |