- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $812.83 / $2,511.89
| Facility | | $602.56 | $812.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $602.56 / $954.99
| Professional | | $501.19 | $602.56 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,698.24 / $2,398.83
| Facility | | $1,659.59 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $758.58 / $1,380.38
| Professional | | $645.65 | $758.58 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,659.59 / $3,467.37
| Facility | | $575.44 | $1,659.59 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $1,023.29
| Professional | | $354.81 | $354.81 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $724.44 / $1,148.15
| Facility | | $602.56 | $724.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $794.33
| Professional | | $758.58 | $758.58 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $891.25 / $933.25
| Facility | | $457.09 | $891.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $870.96
| Professional | | $316.23 | $457.09 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $5,623.41
| Professional | | $3,801.89 | $3,801.89 | $5,623.41 |