- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $954.99 / $7,943.28
| Facility | | $380.19 | $954.99 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $467.74 / $1,122.02
| Professional | | $223.87 | $467.74 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $478.63 / $588.84
| Professional | | $154.88 | $478.63 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,174.90 / $2,290.87
| Facility | | $891.25 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $346.74 / $562.34
| Professional | | $218.78 | $346.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $575.44 / $870.96
| Professional | | $371.54 | $575.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $489.78 / $1,348.96
| Facility | | $251.19 | $489.78 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $575.44 / $1,412.54
| Professional | | $338.84 | $575.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $870.96
| Professional | | $416.87 | $575.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $575.44 / $676.08
| Professional | | $426.58 | $575.44 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,047.13 / $3,801.89
| Facility | | $501.19 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $426.58 / $724.44
| Professional | | $251.19 | $426.58 | $724.44 |