- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $3,715.35 / $19,054.61
| Facility | | $1,122.02 | $3,715.35 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,317.64 / $13,803.84
| Facility | | $5,011.87 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,019.95 / $4,897.79
| Facility | | $2,570.40 | $3,019.95 | $4,897.79 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,412.54 / $8,912.51
| Facility | | $1,023.29 | $1,412.54 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,412.54 / $6,606.93
| Facility | | $1,023.29 | $1,412.54 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | AS | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $2,041.74
| Facility | | $1,479.11 | $1,479.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,290.87 / $3,548.13
| Professional | | $1,258.93 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $9,549.93 / $9,549.93
| Facility | | $1,778.28 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $177.83 / $257.04 / $954.99
| Facility | AS | $177.83 | $257.04 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $3,715.35
| Professional | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $6,760.83 / $19,498.45
| Facility | | $1,995.26 | $6,760.83 | $19,498.45 |