- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $4,073.80 / $38,018.94
| Facility | | $707.95 | $4,073.80 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $933.25 / $3,801.89
| Professional | | $467.74 | $933.25 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Facility | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,380.38 / $2,041.74
| Professional | | $977.24 | $1,380.38 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,000.00 / $1,659.59
| Facility | | $645.65 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,621.81 / $5,128.61
| Professional | | $645.65 | $1,621.81 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,071.52 / $1,698.24
| Professional | | $1,023.29 | $1,071.52 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,047.13 / $1,698.24
| Professional | | $954.99 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,000.00 / $1,318.26
| Professional | | $776.25 | $1,000.00 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | 80 | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | AS | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $6,760.83
| Facility | | $2,691.53 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $977.24 / $1,905.46
| Professional | | $549.54 | $977.24 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,096.48 / $1,621.81
| Professional | | $912.01 | $1,096.48 | $1,621.81 |