- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,630.78 / $9,332.54
| Facility | | $776.25 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,122.02 / $2,454.71
| Professional | | $758.58 | $1,122.02 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $95.50 / $218.78 / $645.65
| Professional | AS | $95.50 | $218.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $812.83 / $1,412.54
| Professional | | $363.08 | $812.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $144.54
| Professional | AS | $125.89 | $125.89 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,715.35 / $11,220.18
| Facility | | $1,174.90 | $3,715.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,000.00 / $1,230.27
| Professional | | $831.76 | $1,000.00 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,949.84 / $2,344.23
| Facility | | $323.59 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,047.13 / $1,819.70
| Professional | | $741.31 | $1,047.13 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,442.29
| Facility | | $6,456.54 | $13,489.63 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $870.96 / $1,288.25
| Professional | | $794.33 | $870.96 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $891.25 / $1,621.81
| Professional | | $32.36 | $891.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $7,585.78 / $12,302.69
| Facility | | $2,630.27 | $7,585.78 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $1,737.80
| Professional | | $691.83 | $977.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $831.76 / $1,174.90
| Professional | | $676.08 | $831.76 | $1,174.90 |