- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $6,165.95 / $9,772.37
| Facility | | $3,090.30 | $6,165.95 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,258.93 / $7,079.46
| Professional | | $524.81 | $1,258.93 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,096.48 / $3,467.37
| Facility | | $537.03 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,096.48 / $1,148.15
| Professional | | $537.03 | $1,096.48 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,258.93 / $1,584.89
| Professional | | $1,047.13 | $1,258.93 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,000.00 / $6,760.83
| Facility | | $776.25 | $1,000.00 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | 50 | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,047.13 / $5,248.07
| Professional | | $512.86 | $1,047.13 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,230.27 / $1,230.27
| Professional | | $1,122.02 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,202.26
| Professional | | $1,122.02 | $1,122.02 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $912.01 / $1,071.52
| Professional | | $676.08 | $912.01 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | 80 | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | AS | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $6,760.83
| Facility | | $3,162.28 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $912.01 / $1,479.11
| Professional | | $616.60 | $912.01 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,318.26 / $1,318.26
| Professional | | $1,071.52 | $1,318.26 | $1,318.26 |