- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $831.76 / $1,348.96
| Facility | | $537.03 | $831.76 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $407.38 / $870.96
| Professional | | $181.97 | $407.38 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $323.59 / $380.19
| Professional | | $218.78 | $323.59 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,023.29 / $1,995.26
| Facility | | $776.25 | $1,023.29 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $354.81 / $363.08
| Professional | | $323.59 | $354.81 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $562.34
| Professional | | $263.03 | $436.52 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $338.84 / $870.96
| Facility | | $181.97 | $338.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $354.81 / $501.19
| Professional | | $218.78 | $354.81 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $416.87 / $660.69
| Professional | | $363.08 | $416.87 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $478.63
| Professional | | $436.52 | $436.52 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $478.63
| Professional | | $223.87 | $354.81 | $478.63 |