- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,659.59 / $8,128.31
| Facility | | $831.76 | $1,659.59 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,096.48 / $3,467.37
| Professional | | $741.31 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $69.18 / $245.47 / $645.65
| Professional | AS | $69.18 | $245.47 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $6,918.31 / $16,595.87
| Facility | | $3,090.30 | $6,918.31 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,187.76 / $3,801.89
| Professional | | $1,412.54 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,981.07 / $9,549.93
| Facility | | $2,818.38 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,884.03 / $4,570.88
| Professional | | $1,778.28 | $2,884.03 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,801.89 / $7,413.10
| Facility | | $3,090.30 | $3,801.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,630.27 / $4,265.80
| Professional | | $1,584.89 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,737.80 / $6,606.93
| Facility | | $933.25 | $1,737.80 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,041.74 / $6,456.54
| Professional | | $1,318.26 | $2,041.74 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $6,760.83 / $10,715.19
| Facility | | $1,584.89 | $6,760.83 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,819.70 / $3,548.13
| Professional | | $1,071.52 | $1,819.70 | $3,548.13 |