- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $6,918.31 / $15,488.17
| Facility | | $691.83 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $12,302.69 / $20,417.38
| Facility | | $9,120.11 | $12,302.69 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,023.29 / $1,621.81
| Facility | | $870.96 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Facility | AS | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $8,912.51
| Facility | | $331.13 | $501.19 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $562.34 / $13,489.63
| Facility | | $338.84 | $562.34 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | AS | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $9,332.54 / $15,848.93
| Facility | | $676.08 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $776.25 / $1,202.26
| Professional | | $426.58 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $16,218.10 / $16,218.10
| Facility | | $588.84 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $58.88 / $1,096.48 / $1,621.81
| Facility | AS | $58.88 | $1,096.48 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Professional | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $12,022.64 / $16,218.10
| Facility | | $5,248.07 | $12,022.64 | $16,218.10 |