- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $407.38 / $457.09
| Facility | | $338.84 | $407.38 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $446.68 / $562.34
| Professional | | $389.05 | $446.68 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $691.83 / $1,258.93
| Facility | | $316.23 | $691.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $281.84 / $331.13
| Professional | | $70.79 | $281.84 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $269.15 / $363.08
| Facility | | $229.09 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $588.84 / $954.99
| Professional | | $416.87 | $588.84 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,890.45 / $3,890.45
| Professional | | $2,818.38 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $501.19 / $794.33
| Facility | | $407.38 | $501.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $446.68 / $562.34
| Professional | | $389.05 | $446.68 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $512.86 / $588.84
| Professional | | $467.74 | $512.86 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,047.13 / $1,258.93
| Professional | | $933.25 | $1,047.13 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $501.19 / $812.83
| Facility | | $407.38 | $501.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $562.34 / $891.25
| Professional | | $338.84 | $562.34 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $389.05 / $549.54
| Facility | | $323.59 | $389.05 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $489.78 / $776.25
| Professional | | $363.08 | $489.78 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $537.03 / $676.08
| Professional | | $354.81 | $537.03 | $676.08 |