- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $3,090.30 / $7,244.36
| Facility | | $501.19 | $3,090.30 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $616.60 / $3,090.30
| Professional | | $426.58 | $616.60 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,047.13 / $2,041.74
| Facility | | $501.19 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,202.26 / $1,513.56
| Professional | | $977.24 | $1,202.26 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $812.83 / $1,288.25
| Facility | | $616.60 | $812.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $912.01 / $5,370.32
| Professional | | $446.68 | $912.01 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,148.15 / $1,148.15
| Professional | | $1,023.29 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,096.48
| Professional | | $1,023.29 | $1,023.29 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $851.14 / $1,000.00
| Professional | | $524.81 | $851.14 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | 80 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $3,981.07
| Facility | | $2,691.53 | $2,691.53 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $831.76 / $1,380.38
| Professional | | $446.68 | $831.76 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,230.27 / $1,230.27
| Professional | | $1,000.00 | $1,230.27 | $1,230.27 |