- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $478.63 / $6,025.60
| Facility | | $436.52 | $478.63 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $478.63 / $870.96
| Professional | | $398.11 | $478.63 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $3,801.89 / $8,128.31
| Facility | | $1,548.82 | $3,801.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,148.15 / $1,778.28
| Professional | | $758.58 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $4,265.80
| Facility | | $1,258.93 | $1,778.28 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,380.38 / $2,089.30
| Professional | | $831.76 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,698.24 / $3,388.44
| Facility | | $1,380.38 | $1,698.24 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,202.26 / $1,949.84
| Professional | | $831.76 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $776.25 / $2,238.72
| Facility | | $457.09 | $776.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 54 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $912.01 / $3,235.94
| Professional | | $478.63 | $912.01 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $4,168.69 / $8,912.51
| Facility | | $1,584.89 | $4,168.69 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $912.01 / $1,737.80
| Professional | | $457.09 | $912.01 | $1,737.80 |