- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $3,630.78 / $8,317.64
| Facility | | $575.44 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $562.34 / $1,230.27
| Professional | | $371.54 | $562.34 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $169.82 / $501.19
| Professional | | $54.95 | $169.82 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,819.70
| Facility | | $1,778.28 | $1,778.28 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $602.56 / $1,174.90
| Professional | | $398.11 | $602.56 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $2,187.76
| Facility | | $602.56 | $602.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $1,000.00
| Professional | | $416.87 | $575.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $933.25
| Professional | | $676.08 | $676.08 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $478.63 / $831.76
| Facility | | $398.11 | $478.63 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $724.44 / $870.96
| Professional | | $588.84 | $724.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $6,606.93 / $10,715.19
| Facility | | $2,187.76 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $467.74 / $851.14
| Professional | | $338.84 | $467.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $7,079.46 / $7,079.46
| Facility | | $56.23 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | AS | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $3,548.13
| Professional | | $2,951.21 | $2,951.21 | $3,548.13 |