- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $6,760.83
| Facility | | $1,584.89 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $741.31 / $1,819.70
| Professional | | $269.15 | $741.31 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $223.87
| Professional | | $213.80 | $213.80 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,511.89 / $4,570.88
| Facility | | $549.54 | $2,511.89 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $794.33 / $2,630.27
| Professional | | $257.04 | $794.33 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $724.44 / $1,230.27
| Professional | | $275.42 | $724.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,000.00 / $6,165.95
| Facility | | $288.40 | $1,000.00 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | AS | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,000.00 / $6,025.60
| Professional | | $741.31 | $1,000.00 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,890.45 / $7,079.46
| Facility | | $2,691.53 | $3,890.45 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $616.60 / $1,148.15
| Professional | | $257.04 | $616.60 | $1,148.15 |