- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,890.45 / $15,135.61
| Facility | | $1,000.00 | $3,890.45 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $446.68 / $933.25
| Professional | | $363.08 | $446.68 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $467.74
| Professional | | $457.09 | $457.09 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,818.38 / $4,466.84
| Facility | | $1,778.28 | $2,818.38 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $501.19 / $549.54
| Professional | | $407.38 | $501.19 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $537.03 / $676.08
| Professional | | $123.03 | $537.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,047.13 / $5,495.41
| Facility | | $416.87 | $1,047.13 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $107.15 / $380.19 / $380.19
| Facility | AS | $107.15 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $478.63 / $794.33
| Professional | | $363.08 | $478.63 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,691.53 / $5,495.41
| Facility | | $891.25 | $2,691.53 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $426.58 / $588.84
| Professional | | $331.13 | $426.58 | $588.84 |