- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $426.58 / $1,548.82
| Facility | | $380.19 | $426.58 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $398.11 / $645.65
| Professional | | $363.08 | $398.11 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,202.26 / $1,548.82
| Facility | | $1,096.48 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $363.08 / $741.31
| Professional | | $316.23 | $363.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,071.52 / $2,238.72
| Facility | | $407.38 | $1,071.52 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $363.08 / $831.76
| Professional | | $229.09 | $363.08 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Professional | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $588.84 / $1,174.90
| Facility | | $389.05 | $588.84 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Professional | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $645.65 / $851.14
| Facility | | $416.87 | $645.65 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $295.12 / $630.96
| Professional | | $190.55 | $295.12 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $4,265.80 / $4,265.80
| Professional | | $3,715.35 | $4,265.80 | $4,265.80 |