- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $4,265.80 / $6,760.83
| Facility | | $933.25 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,023.29 / $2,754.23
| Professional | | $602.56 | $1,023.29 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,778.28 / $2,951.21
| Professional | | $831.76 | $1,778.28 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,174.90 / $2,818.38
| Professional | | $602.56 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,949.84 / $15,135.61
| Facility | | $954.99 | $1,949.84 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | AS | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,819.70 / $6,309.57
| Professional | | $1,000.00 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,698.24 / $2,691.53
| Professional | | $1,380.38 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,698.24 / $2,691.53
| Professional | | $1,318.26 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,096.48 / $2,137.96
| Professional | | $588.84 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $10,232.93 / $19,054.61
| Facility | | $5,495.41 | $10,232.93 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,148.15 / $2,454.71
| Professional | | $602.56 | $1,148.15 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,380.38 / $2,290.87
| Professional | | $1,174.90 | $1,380.38 | $2,290.87 |