- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $6,760.83 / $17,782.79
| Facility | | $1,230.27 | $6,760.83 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $954.99 / $1,862.09
| Professional | | $691.83 | $954.99 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $870.96 / $1,584.89
| Professional | | $741.31 | $870.96 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $4,265.80 / $12,302.69
| Facility | | $1,174.90 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $794.33 / $912.01
| Professional | | $602.56 | $794.33 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $12,589.25 / $53,703.18
| Facility | | $1,479.11 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,000.00 / $2,089.30
| Professional | | $645.65 | $1,000.00 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,442.29
| Facility | | $6,456.54 | $13,489.63 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $575.44 / $954.99
| Professional | | $436.52 | $575.44 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $870.96
| Professional | | $32.36 | $33.11 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $9,332.54 / $15,848.93
| Facility | | $2,818.38 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $870.96 / $1,548.82
| Professional | | $645.65 | $870.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $758.58 / $891.25
| Professional | | $676.08 | $758.58 | $891.25 |