- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $891.25 / $4,365.16
| Facility | | $512.86 | $891.25 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $676.08 / $1,148.15
| Professional | | $457.09 | $676.08 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,479.11 / $2,454.71
| Professional | | $1,071.52 | $1,479.11 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,122.02 / $1,862.09
| Facility | | $724.44 | $1,122.02 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,862.09 / $6,165.95
| Professional | | $741.31 | $1,862.09 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,174.90 / $1,995.26
| Professional | | $1,122.02 | $1,174.90 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,122.02 / $1,949.84
| Professional | | $1,023.29 | $1,122.02 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,122.02 / $1,621.81
| Professional | | $831.76 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Professional | 80 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Professional | AS | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $14,791.08
| Facility | | $3,162.28 | $3,162.28 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,096.48 / $2,290.87
| Professional | | $575.44 | $1,096.48 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,202.26 / $1,949.84
| Professional | | $1,000.00 | $1,202.26 | $1,949.84 |