- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $977.24 / $1,122.02
| Facility | | $562.34 | $977.24 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $501.19 / $954.99
| Professional | | $389.05 | $501.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $2,041.74
| Facility | | $588.84 | $588.84 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $478.63 / $1,071.52
| Professional | | $288.40 | $478.63 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,148.15 / $2,089.30
| Facility | | $1,122.02 | $1,148.15 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $588.84 / $1,348.96
| Professional | | $407.38 | $588.84 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,148.15 / $3,235.94
| Facility | | $562.34 | $1,148.15 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $1,023.29
| Professional | | $288.40 | $416.87 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $724.44 / $3,467.37
| Facility | | $478.63 | $724.44 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $2,951.21
| Professional | | $245.47 | $436.52 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $588.84 / $724.44
| Facility | | $263.03 | $588.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $354.81 / $794.33
| Professional | | $245.47 | $354.81 | $794.33 |