- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $6,025.60 / $10,715.19
| Facility | | $1,122.02 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $741.31 / $1,659.59
| Professional | | $426.58 | $741.31 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $630.96 / $977.24
| Professional | | $436.52 | $630.96 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,630.78 / $11,220.18
| Facility | | $707.95 | $3,630.78 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $501.19 / $562.34
| Professional | | $380.19 | $501.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $707.95 / $812.83
| Facility | | $323.59 | $707.95 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Facility | AS | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $602.56 / $1,000.00
| Professional | | $398.11 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $5,248.07 / $10,471.29
| Facility | | $2,818.38 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $562.34
| Professional | | $275.42 | $380.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $707.95
| Professional | | $32.36 | $33.11 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $5,495.41 / $9,772.37
| Facility | | $1,698.24 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $512.86 / $954.99
| Professional | | $363.08 | $512.86 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $501.19
| Professional | | $363.08 | $363.08 | $501.19 |