- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $371.54 / $398.11
| Facility | | $309.03 | $371.54 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $416.87 / $524.81
| Professional | | $363.08 | $416.87 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $446.68
| Professional | | $416.87 | $416.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $426.58 / $588.84
| Professional | | $338.84 | $426.58 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $371.54 / $416.87
| Facility | | $338.84 | $371.54 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $524.81 / $851.14
| Professional | | $398.11 | $524.81 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,000.00 / $10,000.00
| Professional | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $724.44
| Facility | | $363.08 | $436.52 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $426.58 / $645.65
| Professional | | $363.08 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $295.12 / $338.84
| Professional | | $32.36 | $295.12 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $794.33 / $1,548.82
| Professional | | $371.54 | $794.33 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $446.68 / $724.44
| Facility | | $363.08 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $537.03 / $933.25
| Professional | | $389.05 | $537.03 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $630.96 / $660.69
| Facility | | $446.68 | $630.96 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $446.68 / $707.95
| Professional | | $338.84 | $446.68 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $512.86
| Professional | | $302.00 | $436.52 | $512.86 |