- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,513.56 / $1,949.84
| Facility | | $588.84 | $1,513.56 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $588.84 / $954.99
| Professional | | $524.81 | $588.84 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $4,168.69 / $5,011.87
| Facility | | $3,162.28 | $4,168.69 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $416.87
| Professional | | $239.88 | $239.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $676.08 / $741.31
| Professional | | $616.60 | $676.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,905.46 / $4,073.80
| Facility | | $512.86 | $1,905.46 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $870.96 / $1,122.02
| Professional | | $794.33 | $870.96 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $776.25 / $1,348.96
| Facility | | $602.56 | $776.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $912.01 / $1,659.59
| Facility | | $562.34 | $912.01 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $912.01 / $1,659.59
| Professional | | $562.34 | $912.01 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $794.33 / $954.99
| Facility | | $478.63 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $398.11 / $870.96
| Professional | | $331.13 | $398.11 | $870.96 |