- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $3,311.31 / $10,000.00
| Facility | | $501.19 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $537.03 / $977.24
| Professional | | $288.40 | $537.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $346.74
| Professional | | $147.91 | $147.91 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $4,265.80 / $12,302.69
| Facility | | $851.14 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $776.25
| Professional | | $331.13 | $588.84 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $912.01 / $1,096.48
| Facility | | $323.59 | $912.01 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Facility | AS | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $616.60 / $1,148.15
| Professional | | $323.59 | $616.60 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,309.57 / $11,748.98
| Facility | | $3,548.13 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $549.54 / $741.31
| Professional | | $316.23 | $549.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $190.55 / $776.25
| Professional | | $32.36 | $190.55 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $5,888.44 / $17,782.79
| Facility | | $1,698.24 | $5,888.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $501.19 / $954.99
| Professional | | $269.15 | $501.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $524.81 / $776.25
| Professional | | $257.04 | $524.81 | $776.25 |