- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,412.54 / $33,884.42
| Facility | | $1,148.15 | $1,412.54 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,513.56 / $2,570.40
| Professional | | $1,148.15 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,570.88 / $8,912.51
| Facility | | $2,238.72 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,548.82 / $2,454.71
| Professional | | $794.33 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,445.44 / $2,089.30
| Professional | | $1,258.93 | $1,445.44 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25,118.86 / $25,118.86 / $25,118.86
| Facility | | $25,118.86 | $25,118.86 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,737.80 / $2,884.03
| Professional | | $512.86 | $1,737.80 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $2,238.72 / $10,471.29
| Facility | | $54.95 | $2,238.72 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $331.13 / $645.65 / $645.65
| Facility | AS | $331.13 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,089.30 / $9,772.37
| Professional | | $1,174.90 | $2,089.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,467.37 / $7,762.47
| Facility | | $2,884.03 | $3,467.37 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $3,090.30
| Professional | | $1,230.27 | $1,905.46 | $3,090.30 |