- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $3,019.95 / $7,762.47
| Facility | | $812.83 | $3,019.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,148.15 / $3,019.95
| Professional | | $691.83 | $1,148.15 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $97.72 / $257.04 / $912.01
| Professional | AS | $97.72 | $257.04 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $4,570.88 / $10,964.78
| Facility | | $56.23 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | AS | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,412.54 / $3,019.95
| Professional | | $954.99 | $1,412.54 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $2,344.23
| Facility | | $1,023.29 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,819.70 / $2,818.38
| Professional | | $1,174.90 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $177.83 / $245.47 / $288.40
| Professional | AS | $177.83 | $245.47 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,412.54 / $2,884.03
| Professional | | $933.25 | $1,412.54 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,122.02 / $4,897.79
| Facility | | $794.33 | $1,122.02 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,479.11 / $1,949.84
| Professional | | $1,258.93 | $1,479.11 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $5,248.07 / $11,220.18
| Facility | | $2,398.83 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,513.56 / $2,884.03
| Professional | | $933.25 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,019.95 / $3,388.44
| Facility | | $1,584.89 | $3,019.95 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,737.80 / $3,548.13
| Professional | | $1,698.24 | $1,737.80 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $4,570.88 / $10,964.78
| Facility | | $56.23 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | AS | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,412.54 / $3,019.95
| Professional | | $954.99 | $1,412.54 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $5,248.07 / $11,220.18
| Facility | | $2,041.74 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,479.11 / $3,019.95
| Professional | | $933.25 | $1,479.11 | $3,019.95 |