- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $4,786.30 / $8,317.64
| Facility | | $758.58 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $2,187.76
| Professional | | $537.03 | $776.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $812.83 / $977.24
| Professional | | $501.19 | $812.83 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $891.25 / $1,659.59
| Professional | | $588.84 | $891.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $1,659.59
| Facility | | $524.81 | $524.81 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $776.25 / $1,445.44
| Professional | | $575.44 | $776.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $1,380.38
| Professional | | $812.83 | $812.83 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $741.31 / $1,202.26
| Facility | | $588.84 | $741.31 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $8,511.38
| Facility | | $2,398.83 | $2,398.83 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $954.99 / $1,202.26
| Professional | | $870.96 | $954.99 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $6,606.93 / $10,715.19
| Facility | | $1,548.82 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $645.65 / $1,230.27
| Professional | | $489.78 | $645.65 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $5,370.32 / $28,840.32
| Facility | | $5,370.32 | $5,370.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $537.03
| Facility | AS | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $6,025.60
| Professional | | $6,025.60 | $6,025.60 | $6,025.60 |