- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,388.44 / $10,715.19
| Facility | | $758.58 | $3,388.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $645.65 / $1,174.90
| Professional | | $537.03 | $645.65 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $1,258.93
| Professional | | $630.96 | $630.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,715.35 / $11,220.18
| Facility | | $954.99 | $3,715.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $758.58
| Professional | | $512.86 | $645.65 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,949.84 / $2,344.23
| Facility | | $489.78 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | AS | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $707.95 / $1,288.25
| Professional | | $512.86 | $707.95 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,988.33
| Facility | | $6,456.54 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $478.63 / $707.95
| Professional | | $436.52 | $478.63 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $562.34 / $1,023.29
| Professional | | $32.36 | $562.34 | $1,023.29 |
- 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
- $478.63 / $645.65 / $1,122.02
| Professional | | $478.63 | $645.65 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $691.83
| Professional | | $524.81 | $524.81 | $691.83 |