- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $645.65 / $1,995.26
| Facility | | $288.40 | $645.65 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $331.13 / $426.58
| Professional | | $263.03 | $331.13 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $1,174.90
| Facility | | $288.40 | $346.74 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $645.65
| Professional | | $537.03 | $537.03 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,311.31 / $3,311.31
| Professional | | $2,187.76 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $446.68 / $831.76
| Facility | | $269.15 | $446.68 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $354.81 / $537.03
| Professional | | $263.03 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $478.63 / $954.99
| Professional | | $446.68 | $478.63 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $426.58 / $831.76
| Facility | | $263.03 | $426.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $467.74 / $831.76
| Professional | | $416.87 | $467.74 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $446.68 / $537.03
| Facility | | $186.21 | $446.68 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $316.23
| Professional | | $186.21 | $186.21 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $309.03 / $446.68
| Professional | | $3.39 | $309.03 | $446.68 |