- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $5,495.41 / $9,772.37
| Facility | | $616.60 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $630.96 / $1,949.84
| Professional | | $389.05 | $630.96 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $6,760.83 / $13,182.57
| Facility | | $3,801.89 | $6,760.83 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,258.93 / $2,137.96
| Professional | | $776.25 | $1,258.93 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,238.72 / $5,248.07
| Facility | | $1,584.89 | $2,238.72 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,479.11 / $2,511.89
| Professional | | $870.96 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,137.96 / $4,168.69
| Facility | | $1,698.24 | $2,137.96 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,380.38 / $2,238.72
| Professional | | $870.96 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,318.26 / $6,025.60
| Facility | | $416.87 | $1,318.26 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | AS | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,258.93 / $2,454.71
| Professional | | $630.96 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $5,011.87 / $8,912.51
| Facility | | $2,398.83 | $5,011.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $977.24 / $2,041.74
| Professional | | $489.78 | $977.24 | $2,041.74 |