- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $691.83 / $5,754.40
| Facility | | $316.23 | $691.83 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $588.84 / $1,047.13
| Professional | | $302.00 | $588.84 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $4,265.80 / $8,912.51
| Facility | | $1,949.84 | $4,265.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,202.26 / $2,454.71
| Professional | | $602.56 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,570.40 / $6,025.60
| Facility | | $1,737.80 | $2,570.40 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,348.96 / $2,884.03
| Professional | | $707.95 | $1,348.96 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,398.83 / $4,677.35
| Facility | | $1,949.84 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,288.25 / $2,511.89
| Professional | | $707.95 | $1,288.25 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $891.25 / $4,265.80
| Facility | | $398.11 | $891.25 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,202.26 / $3,019.95
| Professional | | $660.69 | $1,202.26 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $5,011.87 / $8,912.51
| Facility | | $1,584.89 | $5,011.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $870.96 / $1,995.26
| Professional | | $416.87 | $870.96 | $1,995.26 |