- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $14,125.38 / $30,902.95
| Facility | | $1,659.59 | $14,125.38 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,862.09 / $4,786.30
| Professional | | $1,318.26 | $1,862.09 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $186.21 / $302.00 / $831.76
| Professional | AS | $186.21 | $302.00 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,202.26 / $1,819.70
| Professional | | $162.18 | $1,202.26 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,589.25 / $30,902.95 / $56,234.13
| Facility | | $12,589.25 | $30,902.95 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,659.59 / $2,754.23
| Professional | | $1,348.96 | $1,659.59 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $186.21 / $234.42 / $389.05
| Professional | AS | $186.21 | $234.42 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,621.81 / $1,862.09
| Facility | | $1,348.96 | $1,621.81 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,659.59 / $1,862.09
| Professional | | $1,348.96 | $1,659.59 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,290.87 / $3,388.44
| Facility | | $1,584.89 | $2,290.87 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $3,162.28
| Professional | | $1,258.93 | $1,778.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $15,848.93 / $24,547.09
| Facility | | $6,165.95 | $15,848.93 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,621.81 / $2,818.38
| Professional | | $1,174.90 | $1,621.81 | $2,818.38 |