- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $3,090.30 / $4,897.79
| Facility | | $691.83 | $3,090.30 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $758.58 / $1,548.82
| Professional | | $467.74 | $758.58 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $6,165.95 / $45,708.82
| Facility | | $1,202.26 | $6,165.95 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | AS | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $977.24 / $2,818.38
| Professional | | $562.34 | $977.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $1,380.38
| Facility | | $602.56 | $602.56 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,047.13 / $1,862.09
| Professional | | $602.56 | $1,047.13 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $954.99 / $2,041.74
| Professional | | $512.86 | $954.99 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $707.95 / $3,630.78
| Facility | | $489.78 | $707.95 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,202.26 / $1,513.56
| Professional | | $977.24 | $1,202.26 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $5,248.07 / $11,220.18
| Facility | | $2,398.83 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,071.52 / $2,187.76
| Professional | | $588.84 | $1,071.52 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $16,982.44
| Facility | | $4,073.80 | $4,073.80 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $354.81 / $1,318.26
| Professional | | $42.66 | $354.81 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $6,165.95 / $45,708.82
| Facility | | $1,202.26 | $6,165.95 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | AS | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $977.24 / $2,818.38
| Professional | | $562.34 | $977.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $5,248.07 / $13,182.57
| Facility | | $2,041.74 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,047.13 / $2,290.87
| Professional | | $588.84 | $1,047.13 | $2,290.87 |