- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $10,000.00 / $15,848.93
| Facility | | $933.25 | $10,000.00 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,122.02 / $2,570.40
| Professional | | $891.25 | $1,122.02 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,479.11 / $2,238.72
| Professional | | $1,348.96 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $8,128.31 / $30,902.95
| Facility | | $1,445.44 | $8,128.31 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,096.48 / $1,318.26
| Professional | | $870.96 | $1,096.48 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $28,840.32 / $36,307.81
| Facility | | $1,737.80 | $28,840.32 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | AS | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,348.96 / $2,238.72
| Professional | | $870.96 | $1,348.96 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,884.03 / $6,760.83
| Facility | | $1,548.82 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $812.83 / $1,047.13
| Professional | | $758.58 | $812.83 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,479.11
| Professional | | $32.36 | $33.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $12,589.25 / $19,054.61
| Facility | | $4,168.69 | $12,589.25 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,230.27 / $2,290.87
| Professional | | $794.33 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $1,174.90
| Professional | | $794.33 | $794.33 | $1,174.90 |