- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $537.03 / $602.56
| Facility | | $457.09 | $537.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $549.54
| Professional | | $269.15 | $363.08 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $776.25
| Facility | | $467.74 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $831.76 / $1,047.13
| Professional | | $467.74 | $831.76 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $758.58 / $912.01
| Professional | | $616.60 | $758.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $891.25 / $3,311.31
| Facility | | $467.74 | $891.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $467.74 / $1,148.15
| Professional | | $323.59 | $467.74 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $794.33 / $954.99
| Professional | | $758.58 | $794.33 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,148.15 / $1,148.15
| Professional | | $724.44 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $707.95 / $1,659.59
| Facility | | $309.03 | $707.95 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $371.54 / $660.69
| Professional | | $316.23 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $676.08 / $676.08
| Professional | | $537.03 | $676.08 | $676.08 |