- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $6,760.83 / $8,912.51
| Facility | | $1,023.29 | $6,760.83 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,023.29 / $3,019.95
| Professional | | $501.19 | $1,023.29 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $724.44 / $1,174.90
| Professional | | $446.68 | $724.44 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $5,623.41 / $11,481.54
| Facility | | $4,466.84 | $5,623.41 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $831.76 / $1,202.26
| Professional | | $501.19 | $831.76 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,258.93 / $1,621.81
| Professional | | $588.84 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $2,137.96 / $7,413.10
| Facility | | $616.60 | $2,137.96 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $141.25 / $851.14 / $851.14
| Facility | AS | $141.25 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,047.13 / $1,445.44
| Professional | | $602.56 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,230.27 / $1,698.24
| Professional | | $1,047.13 | $1,230.27 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,202.26 / $1,698.24
| Professional | | $1,047.13 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $7,079.46
| Facility | | $6,025.60 | $6,025.60 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $933.25 / $1,202.26
| Professional | | $524.81 | $933.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,897.79 / $7,585.78
| Facility | | $4,073.80 | $4,897.79 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,000.00 / $1,479.11
| Professional | | $616.60 | $1,000.00 | $1,479.11 |