- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $12,882.50 / $28,183.83
| Facility | | $4,265.80 | $12,882.50 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,621.81 / $6,025.60
| Professional | | $831.76 | $1,621.81 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $165.96 / $380.19 / $954.99
| Professional | AS | $165.96 | $380.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,318.26 / $1,819.70
| Professional | | $234.42 | $1,318.26 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $14,454.40 / $19,054.61
| Facility | | $10,715.19 | $14,454.40 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,737.80 / $2,398.83
| Professional | | $1,348.96 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $165.96 / $194.98 / $218.78
| Professional | AS | $165.96 | $194.98 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15,848.93 / $17,782.79 / $23,442.29
| Facility | | $15,848.93 | $17,782.79 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $2,884.03
| Professional | | $1,258.93 | $1,778.28 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $1,258.93 / $2,454.71
| Professional | | $22.91 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $1,698.24
| Professional | | $19.50 | $19.50 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $2,344.23
| Professional | | $1,148.15 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $10,964.78 / $26,302.68
| Facility | | $3,715.35 | $10,964.78 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,659.59 / $3,162.28
| Professional | | $1,202.26 | $1,659.59 | $3,162.28 |