- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,348.96 / $2,511.89
| Facility | | $1,258.93 | $1,348.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,288.25 / $1,548.82
| Professional | | $1,258.93 | $1,288.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $467.74 / $1,318.26
| Professional | | $380.19 | $467.74 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $776.25 / $1,202.26
| Professional | | $426.58 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $363.08 / $575.44
| Facility | | $204.17 | $363.08 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,288.25 / $1,584.89
| Professional | | $398.11 | $1,288.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $398.11 / $501.19
| Professional | | $204.17 | $398.11 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $676.08 / $912.01
| Professional | | $331.13 | $676.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $501.19 / $776.25
| Professional | | $30.20 | $501.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $416.87
| Facility | | $281.84 | $281.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,288.25 / $1,548.82
| Professional | | $380.19 | $1,288.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $407.38 / $407.38
| Professional | | $323.59 | $407.38 | $407.38 |