- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,288.25 / $14,454.40
| Facility | | $676.08 | $1,288.25 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $12,302.69 / $20,892.96
| Facility | | $9,120.11 | $12,302.69 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,862.09 / $3,019.95
| Facility | | $1,621.81 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $851.14 / $8,912.51
| Facility | | $616.60 | $851.14 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $933.25 / $13,489.63
| Facility | | $616.60 | $933.25 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | AS | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $9,332.54 / $15,848.93
| Facility | | $1,258.93 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,412.54 / $2,187.76
| Professional | | $794.33 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $13,489.63 / $13,489.63
| Facility | | $1,096.48 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $109.65 / $891.25 / $1,348.96
| Facility | AS | $109.65 | $891.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | | $2,238.72 | $2,238.72 | $2,238.72 |
- 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 |