- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $5,888.44 / $17,782.79
| Facility | | $2,570.40 | $5,888.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,905.46 / $5,754.40
| Professional | | $1,288.25 | $1,905.46 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $181.97 / $380.19 / $954.99
| Professional | AS | $181.97 | $380.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $1,288.25 / $1,737.80
| Professional | | $173.78 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $7,943.28 / $14,791.08
| Facility | | $1,737.80 | $7,943.28 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,238.72 / $4,073.80
| Professional | | $1,698.24 | $2,238.72 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,737.80 / $2,884.03
| Professional | | $1,288.25 | $1,737.80 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,995.26 / $15,135.61
| Facility | | $1,380.38 | $1,995.26 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $7,762.47
| Facility | AS | $363.08 | $363.08 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,778.28 / $10,715.19
| Professional | | $1,288.25 | $1,778.28 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $11,220.18 / $18,197.01
| Facility | | $4,570.88 | $11,220.18 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,513.56 / $2,630.27
| Professional | | $1,230.27 | $1,513.56 | $2,630.27 |