- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $5,248.07 / $9,332.54
| Facility | | $2,041.74 | $5,248.07 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- 80
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Facility | 80 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,621.81 / $4,897.79
| Professional | | $912.01 | $1,621.81 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $954.99 / $1,202.26
| Professional | | $131.83 | $954.99 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $3,981.07 / $7,244.36
| Facility | | $891.25 | $3,981.07 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,659.59 / $3,019.95
| Professional | | $1,258.93 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,258.93 / $2,089.30
| Professional | | $954.99 | $1,258.93 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,479.11 / $9,332.54
| Facility | | $1,023.29 | $1,479.11 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $1,905.46
| Facility | AS | $269.15 | $269.15 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,288.25 / $7,943.28
| Professional | | $933.25 | $1,288.25 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $6,760.83 / $10,964.78
| Facility | | $5,495.41 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,122.02 / $1,949.84
| Professional | | $891.25 | $1,122.02 | $1,949.84 |