- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,778.28 / $6,606.93
| Facility | | $630.96 | $1,778.28 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $602.56 / $1,949.84
| Professional | | $346.74 | $602.56 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,148.15 / $1,698.24
| Professional | | $478.63 | $1,148.15 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $676.08 / $1,513.56
| Professional | | $363.08 | $676.08 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,174.90 / $7,413.10
| Facility | | $588.84 | $1,174.90 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | AS | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,071.52 / $3,630.78
| Professional | | $575.44 | $1,071.52 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,047.13 / $1,513.56
| Professional | | $870.96 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $1,513.56
| Professional | | $724.44 | $1,071.52 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $691.83 / $1,202.26
| Professional | | $380.19 | $691.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $6,309.57 / $8,912.51
| Facility | | $4,168.69 | $6,309.57 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $660.69 / $1,412.54
| Professional | | $389.05 | $660.69 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $891.25 / $1,288.25
| Professional | | $758.58 | $891.25 | $1,288.25 |