- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $6,760.83 / $11,481.54
| Facility | | $1,778.28 | $6,760.83 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,398.83 / $13,182.57
| Professional | | $954.99 | $2,398.83 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,137.96 / $7,943.28
| Facility | | $1,023.29 | $2,137.96 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,089.30 / $2,187.76
| Professional | | $1,023.29 | $2,089.30 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,454.71 / $3,090.30
| Professional | | $2,041.74 | $2,454.71 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,778.28 / $6,918.31
| Facility | | $1,380.38 | $1,778.28 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,089.30 / $7,943.28
| Professional | | $1,000.00 | $2,089.30 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,398.83 / $2,398.83
| Professional | | $2,238.72 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,344.23
| Professional | | $2,238.72 | $2,238.72 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $2,089.30
| Professional | | $1,258.93 | $1,778.28 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Professional | 80 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Professional | AS | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $5,370.32 / $14,791.08
| Facility | | $5,370.32 | $5,370.32 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,819.70 / $2,951.21
| Professional | | $1,071.52 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,570.40 / $2,570.40
| Professional | | $2,089.30 | $2,570.40 | $2,570.40 |