- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $6,165.95 / $7,079.46
| Facility | | $602.56 | $6,165.95 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,096.48 / $10,964.78
| Professional | | $602.56 | $1,096.48 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $2,951.21
| Professional | | $1,258.93 | $1,778.28 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,380.38 / $2,344.23
| Facility | | $851.14 | $1,380.38 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,187.76 / $7,585.78
| Professional | | $891.25 | $2,187.76 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,380.38 / $2,344.23
| Professional | | $1,318.26 | $1,380.38 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,318.26 / $2,290.87
| Professional | | $1,202.26 | $1,318.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,348.96 / $1,949.84
| Professional | | $1,000.00 | $1,348.96 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Professional | 80 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Professional | AS | $389.05 | $389.05 | $389.05 |
- 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
- $691.83 / $1,318.26 / $2,754.23
| Professional | | $691.83 | $1,318.26 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,412.54 / $2,344.23
| Professional | | $1,174.90 | $1,412.54 | $2,344.23 |