- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $7,079.46 / $26,915.35
| Facility | | $1,862.09 | $7,079.46 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,041.74 / $5,248.07
| Professional | | $1,288.25 | $2,041.74 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $208.93 / $457.09 / $954.99
| Professional | AS | $208.93 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,202.26 / $1,778.28
| Professional | | $162.18 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15,848.93 / $25,118.86 / $33,884.42
| Facility | | $15,848.93 | $25,118.86 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,454.71 / $2,951.21
| Professional | | $1,778.28 | $2,454.71 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $10,964.78 / $28,183.83
| Facility | | $6,456.54 | $10,964.78 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,041.74 / $3,090.30
| Professional | | $1,348.96 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,398.83 / $8,912.51
| Professional | | $1,548.82 | $2,398.83 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,862.09 / $2,041.74
| Professional | | $1,698.24 | $1,862.09 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,513.56
| Professional | | $32.36 | $33.11 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $10,964.78 / $26,302.68
| Facility | | $4,073.80 | $10,964.78 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $1,778.28 / $3,388.44
| Professional | | $100.00 | $1,778.28 | $3,388.44 |