- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $4,365.16 / $10,000.00
| Facility | | $1,096.48 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $309.03 / $1,862.09
| Professional | | $162.18 | $309.03 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $213.80 / $316.23
| Professional | | $30.90 | $213.80 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $5,623.41 / $15,135.61
| Facility | | $1,230.27 | $5,623.41 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $645.65 / $1,230.27
| Professional | | $204.17 | $645.65 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $338.84
| Facility | | $204.17 | $239.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $204.17 / $239.88
| Professional | | $158.49 | $204.17 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $7,244.36 / $10,000.00
| Facility | | $4,168.69 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $1,258.93
| Professional | | $186.21 | $338.84 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $245.47 / $2,754.23
| Professional | | $165.96 | $245.47 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $13.49
| Professional | 80 | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $6.76
| Professional | AS | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $16,218.10 / $16,218.10
| Facility | | $5,248.07 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $281.84 / $346.74
| Professional | | $165.96 | $281.84 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,348.96 / $2,344.23
| Facility | | $213.80 | $1,348.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $295.12 / $1,000.00
| Professional | | $154.88 | $295.12 | $1,000.00 |