- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $6,025.60 / $22,387.21
| Facility | | $870.96 | $6,025.60 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $912.01 / $1,737.80
| Professional | | $549.54 | $912.01 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,071.52 / $1,096.48
| Professional | | $562.34 | $1,071.52 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $4,897.79 / $13,489.63
| Facility | | $954.99 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $812.83 / $1,122.02
| Professional | | $588.84 | $812.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $9,772.37 / $11,748.98
| Facility | | $489.78 | $9,772.37 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | AS | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $954.99 / $1,698.24
| Professional | | $575.44 | $954.99 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,988.33
| Facility | | $6,456.54 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $758.58 / $1,023.29
| Professional | | $426.58 | $758.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $478.63 / $1,380.38
| Professional | | $32.36 | $478.63 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $7,943.28 / $14,125.38
| Facility | | $2,630.27 | $7,943.28 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $794.33 / $1,584.89
| Professional | | $489.78 | $794.33 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $776.25 / $1,071.52
| Professional | | $467.74 | $776.25 | $1,071.52 |