- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $575.44 / $1,479.11
| Facility | | $478.63 | $575.44 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $575.44 / $977.24
| Professional | | $478.63 | $575.44 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $1,258.93
| Facility | | $1,174.90 | $1,174.90 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $1,380.38
| Professional | | $660.69 | $660.69 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $812.83
| Professional | | $630.96 | $630.96 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $741.31
| Facility | | $478.63 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $741.31
| Professional | | $537.03 | $537.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,174.90 / $1,659.59
| Professional | | $891.25 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $776.25 / $1,174.90
| Professional | | $630.96 | $776.25 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $776.25 / $1,380.38
| Facility | | $478.63 | $776.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $691.83 / $1,479.11
| Professional | | $630.96 | $691.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $977.24 / $2,570.40
| Facility | | $676.08 | $977.24 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $977.24 / $2,570.40
| Professional | | $676.08 | $977.24 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $549.54 / $1,174.90
| Facility | | $346.74 | $549.54 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $575.44 / $954.99
| Professional | | $524.81 | $575.44 | $954.99 |