- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $549.54
| Facility | | $354.81 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $524.81 / $912.01
| Professional | | $338.84 | $524.81 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $7,585.78 / $22,908.68
| Facility | | $4,265.80 | $7,585.78 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,071.52 / $1,862.09
| Professional | | $645.65 | $1,071.52 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,949.84 / $4,677.35
| Facility | | $1,380.38 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,230.27 / $2,187.76
| Professional | | $741.31 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,862.09 / $3,630.78
| Facility | | $1,479.11 | $1,862.09 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,174.90 / $2,089.30
| Professional | | $758.58 | $1,174.90 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $741.31 / $3,311.31
| Facility | | $426.58 | $741.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | AS | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,096.48 / $2,630.27
| Professional | | $537.03 | $1,096.48 | $2,630.27 |
- 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
- $446.68 / $851.14 / $1,659.59
| Professional | | $446.68 | $851.14 | $1,659.59 |