- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $630.96 / $1,621.81
| Facility | | $512.86 | $630.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $630.96 / $1,148.15
| Professional | | $512.86 | $630.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,380.38
| Facility | | $1,288.25 | $1,288.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $1,584.89
| Professional | | $758.58 | $758.58 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $891.25
| Professional | | $794.33 | $794.33 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $724.44 / $724.44
| Facility | | $549.54 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $724.44
| Professional | | $524.81 | $524.81 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,288.25 / $1,819.70
| Professional | | $977.24 | $1,288.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $851.14 / $1,412.54
| Facility | | $588.84 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $776.25 / $1,621.81
| Professional | | $691.83 | $776.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,047.13 / $1,778.28
| Facility | | $707.95 | $1,047.13 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,047.13 / $1,778.28
| Professional | | $707.95 | $1,047.13 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $575.44 / $1,584.89
| Facility | | $389.05 | $575.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $630.96 / $1,047.13
| Professional | | $575.44 | $630.96 | $1,047.13 |