- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $512.86 / $1,348.96
| Facility | | $426.58 | $512.86 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $512.86 / $954.99
| Professional | | $426.58 | $512.86 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,148.15
| Facility | | $1,071.52 | $1,071.52 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $1,202.26
| Professional | | $575.44 | $575.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $741.31
| Professional | | $645.65 | $645.65 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $724.44 / $724.44
| Facility | | $457.09 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $660.69
| Professional | | $537.03 | $537.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $1,513.56
| Professional | | $794.33 | $1,071.52 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $707.95 / $1,047.13
| Professional | | $537.03 | $707.95 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $691.83 / $1,230.27
| Facility | | $426.58 | $691.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $645.65 / $1,348.96
| Professional | | $575.44 | $645.65 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $870.96 / $2,290.87
| Facility | | $602.56 | $870.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $870.96 / $2,290.87
| Professional | | $602.56 | $870.96 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $1,318.26
| Facility | | $323.59 | $478.63 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $524.81 / $851.14
| Professional | | $478.63 | $524.81 | $851.14 |