- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,548.13 / $7,762.47
| Facility | | $602.56 | $3,548.13 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $870.96 / $2,238.72
| Professional | | $575.44 | $870.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,513.56 / $1,737.80
| Professional | | $1,380.38 | $1,513.56 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $954.99 / $2,041.74
| Professional | | $602.56 | $954.99 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $5,370.32 / $9,549.93
| Facility | | $1,148.15 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | AS | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,288.25 / $2,041.74
| Professional | | $724.44 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,548.82 / $1,949.84
| Professional | | $1,288.25 | $1,548.82 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $2,041.74
| Professional | | $1,380.38 | $1,380.38 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,122.02 / $1,513.56
| Professional | | $645.65 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $7,079.46 / $10,232.93
| Facility | | $4,168.69 | $7,079.46 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,000.00 / $2,041.74
| Professional | | $616.60 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,288.25 / $1,513.56
| Professional | | $1,023.29 | $1,288.25 | $1,513.56 |