- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $489.78 / $1,258.93
| Facility | | $407.38 | $489.78 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $489.78 / $891.25
| Professional | | $407.38 | $489.78 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,071.52
| Facility | | $1,000.00 | $1,000.00 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $1,148.15
| Professional | | $549.54 | $549.54 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $691.83
| Professional | | $602.56 | $602.56 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $707.95 / $707.95
| Facility | | $426.58 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $616.60
| Professional | | $512.86 | $512.86 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,000.00 / $1,412.54
| Professional | | $758.58 | $1,000.00 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $660.69 / $1,000.00
| Professional | | $512.86 | $660.69 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $645.65 / $1,148.15
| Facility | | $407.38 | $645.65 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $616.60 / $1,258.93
| Professional | | $537.03 | $616.60 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $831.76 / $2,187.76
| Facility | | $575.44 | $831.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $831.76 / $2,187.76
| Professional | | $575.44 | $831.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $446.68 / $1,230.27
| Facility | | $309.03 | $446.68 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $489.78 / $812.83
| Professional | | $446.68 | $489.78 | $812.83 |