- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $6,456.54 / $16,595.87
| Facility | | $933.25 | $6,456.54 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $912.01 / $1,737.80
| Professional | | $575.44 | $912.01 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $562.34 / $1,096.48
| Professional | | $102.33 | $562.34 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $4,677.35 / $11,220.18
| Facility | | $1,122.02 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $831.76 / $1,071.52
| Professional | | $602.56 | $831.76 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $4,466.84 / $4,897.79
| Facility | | $691.83 | $4,466.84 | $4,897.79 |
- 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
- $562.34 / $977.24 / $1,698.24
| Professional | | $562.34 | $977.24 | $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
- $467.74 / $776.25 / $1,023.29
| Professional | | $467.74 | $776.25 | $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 / $12,882.50
| Facility | | $2,630.27 | $7,943.28 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $812.83 / $1,548.82
| Professional | | $512.86 | $812.83 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $776.25 / $1,071.52
| Professional | | $467.74 | $776.25 | $1,071.52 |