- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $489.78 / $1,318.26
| Facility | | $436.52 | $489.78 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $489.78 / $870.96
| Professional | | $407.38 | $489.78 | $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 / $1,174.90 / $1,778.28
| Professional | | $758.58 | $1,174.90 | $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 / $2,137.96
| Professional | | $831.76 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,737.80 / $3,388.44
| Facility | | $1,380.38 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,230.27 / $1,949.84
| Professional | | $831.76 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $794.33 / $2,041.74
| Facility | | $467.74 | $794.33 | $2,041.74 |
- 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 / $933.25 / $3,235.94
| Professional | | $478.63 | $933.25 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,162.28 / $5,754.40
| Facility | | $1,174.90 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $912.01 / $1,698.24
| Professional | | $457.09 | $912.01 | $1,698.24 |