- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,479.11 / $5,495.41
| Facility | | $389.05 | $1,479.11 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $371.54 / $831.76
| Professional | | $251.19 | $371.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $616.60 / $1,862.09
| Professional | | $331.13 | $616.60 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $602.56
| Facility | | $446.68 | $446.68 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $446.68 / $794.33
| Professional | | $309.03 | $446.68 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $891.25
| Professional | | $549.54 | $549.54 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $416.87 / $691.83
| Facility | | $275.42 | $416.87 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $741.31 / $870.96
| Professional | | $575.44 | $741.31 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $6,760.83 / $10,715.19
| Facility | | $2,344.23 | $6,760.83 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $380.19 / $691.83
| Professional | | $251.19 | $380.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,398.83 / $2,398.83
| Facility | | $56.23 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $3,162.28
| Professional | | $2,691.53 | $2,691.53 | $3,162.28 |