- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,258.93 / $1,621.81
| Facility | | $501.19 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $501.19 / $794.33
| Professional | | $436.52 | $501.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,467.37 / $4,168.69
| Facility | | $2,630.27 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $3,388.44
| Professional | | $1,995.26 | $1,995.26 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $562.34 / $616.60
| Professional | | $512.86 | $562.34 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,584.89 / $3,388.44
| Facility | | $426.58 | $1,584.89 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $724.44 / $933.25
| Professional | | $660.69 | $724.44 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $645.65 / $1,122.02
| Facility | | $501.19 | $645.65 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $758.58 / $1,348.96
| Facility | | $467.74 | $758.58 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $758.58 / $1,380.38
| Professional | | $467.74 | $758.58 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $660.69 / $794.33
| Facility | | $398.11 | $660.69 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $331.13 / $724.44
| Professional | | $275.42 | $331.13 | $724.44 |