- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $549.54 / $707.95
| Facility | | $467.74 | $549.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $562.34
| Professional | | $275.42 | $426.58 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $794.33
| Facility | | $398.11 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $977.24 / $1,230.27
| Professional | | $398.11 | $977.24 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $851.14 / $912.01
| Professional | | $645.65 | $851.14 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $912.01 / $3,630.78
| Facility | | $478.63 | $912.01 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $478.63 / $1,230.27
| Professional | | $338.84 | $478.63 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $812.83 / $977.24
| Professional | | $776.25 | $812.83 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,174.90 / $1,174.90
| Professional | | $741.31 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $724.44 / $1,698.24
| Facility | | $316.23 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $380.19 / $707.95
| Professional | | $331.13 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $691.83 / $691.83
| Professional | | $549.54 | $691.83 | $691.83 |