- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $4,265.80 / $6,760.83
| Facility | | $616.60 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $954.99 / $1,819.70
| Professional | | $575.44 | $954.99 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,621.81 / $1,995.26
| Professional | | $1,584.89 | $1,621.81 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,071.52 / $2,089.30
| Professional | | $691.83 | $1,071.52 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $7,762.47 / $16,218.10
| Facility | | $1,288.25 | $7,762.47 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | AS | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,445.44 / $2,290.87
| Professional | | $776.25 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,778.28 / $2,187.76
| Professional | | $1,445.44 | $1,778.28 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $2,290.87
| Professional | | $1,148.15 | $1,148.15 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,288.25 / $1,737.80
| Professional | | $741.31 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $11,481.54 / $14,791.08
| Facility | | $7,244.36 | $11,481.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,122.02 / $2,290.87
| Professional | | $707.95 | $1,122.02 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,479.11 / $1,737.80
| Professional | | $1,174.90 | $1,479.11 | $1,737.80 |