- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,691.53 / $9,549.93
| Facility | | $524.81 | $2,691.53 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $660.69 / $2,238.72
| Professional | | $478.63 | $660.69 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $6,309.57 / $13,182.57
| Facility | | $3,090.30 | $6,309.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,318.26 / $1,905.46
| Professional | | $870.96 | $1,318.26 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,905.46 / $4,466.84
| Facility | | $1,348.96 | $1,905.46 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,548.82 / $2,290.87
| Professional | | $912.01 | $1,548.82 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,819.70 / $3,548.13
| Facility | | $1,479.11 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,288.25 / $2,041.74
| Professional | | $912.01 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,047.13 / $4,365.16
| Facility | | $524.81 | $1,047.13 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | AS | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $977.24 / $2,884.03
| Professional | | $512.86 | $977.24 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,162.28 / $7,585.78
| Facility | | $1,174.90 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,000.00 / $1,862.09
| Professional | | $524.81 | $1,000.00 | $1,862.09 |