- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,230.27 / $2,290.87
| Facility | | $436.52 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $457.09 / $707.95
| Professional | | $389.05 | $457.09 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $2,511.89
| Facility | | $588.84 | $588.84 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $489.78
| Professional | | $288.40 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $489.78 / $549.54
| Professional | | $446.68 | $489.78 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,148.15 / $2,630.27
| Facility | | $407.38 | $1,148.15 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $436.52 / $1,148.15
| Professional | | $323.59 | $436.52 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $645.65 / $812.83
| Professional | | $588.84 | $645.65 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $467.74 / $1,071.52
| Facility | | $371.54 | $467.74 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $1,230.27
| Professional | | $467.74 | $467.74 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $794.33 / $10,000.00
| Facility | | $524.81 | $794.33 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $794.33 / $10,000.00
| Professional | | $524.81 | $794.33 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $588.84 / $954.99
| Facility | | $245.47 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $354.81 / $794.33
| Professional | | $245.47 | $354.81 | $794.33 |