- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $602.56 / $891.25
| Facility | | $512.86 | $602.56 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $446.68 / $616.60
| Professional | | $346.74 | $446.68 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,023.29 / $2,089.30
| Facility | | $977.24 | $1,023.29 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $562.34 / $1,258.93
| Professional | | $467.74 | $562.34 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $645.65 / $912.01
| Facility | | $380.19 | $645.65 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $691.83 / $1,023.29
| Professional | | $501.19 | $691.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $575.44
| Facility | | $549.54 | $549.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $549.54
| Professional | | $398.11 | $398.11 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $549.54
| Professional | | $398.11 | $398.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $831.76
| Professional | | $416.87 | $575.44 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,096.48 / $1,995.26
| Professional | | $912.01 | $1,096.48 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $630.96 / $977.24
| Facility | | $302.00 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $436.52 / $602.56
| Professional | | $295.12 | $436.52 | $602.56 |