- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,698.24 / $14,454.40
| Facility | | $912.01 | $1,698.24 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $4,786.30 / $7,413.10
| Facility | | $3,162.28 | $4,786.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,511.89 / $3,981.07
| Facility | | $2,137.96 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Facility | AS | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,148.15 / $8,912.51
| Facility | | $812.83 | $1,148.15 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,174.90 / $7,943.28
| Facility | | $812.83 | $1,174.90 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | AS | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $5,754.40 / $7,762.47
| Facility | | $1,659.59 | $5,754.40 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,905.46 / $2,951.21
| Professional | | $1,047.13 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $7,762.47 / $7,762.47
| Facility | | $1,445.44 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $776.25
| Facility | AS | $144.54 | $208.93 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $3,019.95
| Professional | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $7,413.10 / $9,120.11
| Facility | | $4,786.30 | $7,413.10 | $9,120.11 |