- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,258.93 / $8,317.64
| Facility | | $398.11 | $1,258.93 | $8,317.64 |
- 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
- $933.25 / $1,096.48 / $1,737.80
| Facility | | $933.25 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | AS | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $549.54 / $8,912.51
| Facility | | $363.08 | $549.54 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $616.60 / $13,489.63
| Facility | | $363.08 | $616.60 | $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
- $724.44 / $9,332.54 / $15,848.93
| Facility | | $724.44 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $831.76 / $1,288.25
| Professional | | $457.09 | $831.76 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $16,218.10 / $16,218.10
| Facility | | $645.65 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $64.57 / $1,096.48 / $1,621.81
| Facility | AS | $64.57 | $1,096.48 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Professional | | $1,318.26 | $1,318.26 | $1,318.26 |
- 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 |