- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,584.89 / $12,882.50
| Facility | | $977.24 | $1,584.89 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,288.25 / $3,235.94
| Professional | | $933.25 | $1,288.25 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,380.38 / $1,778.28
| Professional | | $1,258.93 | $1,380.38 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,862.09 / $2,511.89
| Professional | | $977.24 | $1,862.09 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,479.11 / $2,570.40
| Professional | | $891.25 | $1,479.11 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,202.26 / $1,862.09
| Facility | | $977.24 | $1,202.26 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $2,754.23
| Professional | | $575.44 | $575.44 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $16,982.44 / $23,442.29
| Facility | | $7,079.46 | $16,982.44 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,122.02 / $2,137.96
| Professional | | $851.14 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $6,165.95 / $6,165.95
| Facility | | $56.23 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | AS | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $9,120.11 / $9,120.11
| Professional | | $7,079.46 | $9,120.11 | $9,120.11 |