- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $575.44 / $1,148.15
| Facility | | $398.11 | $575.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $660.69
| Professional | | $389.05 | $389.05 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $870.96
| Facility | | $489.78 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $489.78
| Professional | | $389.05 | $389.05 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $489.78 / $1,023.29
| Facility | | $389.05 | $489.78 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $489.78 / $707.95
| Professional | | $389.05 | $489.78 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $380.19 / $831.76
| Facility | | $316.23 | $380.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $758.58
| Professional | | $575.44 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $380.19 / $831.76
| Facility | | $316.23 | $380.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $602.56
| Professional | | $380.19 | $380.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $85.11
| Professional | | $64.57 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $389.05 / $389.05
| Facility | | $380.19 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $512.86 / $1,148.15
| Professional | | $389.05 | $512.86 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $1,905.46
| Facility | | $389.05 | $389.05 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Professional | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $524.81 / $645.65
| Professional | | $436.52 | $524.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $870.96
| Facility | | $371.54 | $371.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $524.81
| Professional | | $389.05 | $389.05 | $524.81 |