- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $5,623.41 / $11,220.18
| Facility | | $870.96 | $5,623.41 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $14,791.08 / $14,791.08 / $14,791.08
| Facility | AS | $14,791.08 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $912.01 / $2,754.23
| Professional | | $524.81 | $912.01 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $575.44 / $741.31
| Professional | | $512.86 | $575.44 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,897.79 / $13,489.63
| Facility | | $4,073.80 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,023.29 / $1,096.48
| Professional | | $691.83 | $1,023.29 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $9,772.37 / $10,000.00
| Facility | | $3,090.30 | $9,772.37 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $831.76 / $1,288.25
| Professional | | $537.03 | $831.76 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,000.00 / $5,128.61
| Professional | | $616.60 | $1,000.00 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $724.44 / $794.33
| Professional | | $676.08 | $724.44 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $602.56
| Professional | | $32.36 | $33.11 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $4,365.16 / $8,912.51
| Facility | | $2,754.23 | $4,365.16 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $776.25 / $1,737.80
| Professional | | $489.78 | $776.25 | $1,737.80 |