- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $3,467.37 / $3,890.45
| Facility | | $512.86 | $3,467.37 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $831.76 / $1,949.84
| Professional | | $489.78 | $831.76 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $5,623.41 / $12,589.25
| Facility | | $3,090.30 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,737.80 / $3,162.28
| Professional | | $954.99 | $1,737.80 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,311.31 / $7,943.28
| Facility | | $2,344.23 | $3,311.31 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,995.26 / $3,715.35
| Professional | | $1,122.02 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,162.28 / $6,165.95
| Facility | | $2,511.89 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,862.09 / $3,548.13
| Professional | | $1,148.15 | $1,862.09 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,230.27 / $5,495.41
| Facility | | $645.65 | $1,230.27 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | AS | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,778.28 / $4,786.30
| Professional | | $891.25 | $1,778.28 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $6,025.60 / $10,715.19
| Facility | | $3,090.30 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,348.96 / $2,884.03
| Professional | | $660.69 | $1,348.96 | $2,884.03 |