- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $776.25 / $776.25
| Facility | | $691.83 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,288.25 / $1,778.28
| Professional | | $776.25 | $1,288.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $389.05
| Facility | | $123.03 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,122.02 / $6,760.83
| Professional | | $912.01 | $1,122.02 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $363.08 / $575.44
| Facility | | $147.91 | $363.08 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,951.21 / $4,073.80
| Professional | | $2,187.76 | $2,951.21 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $1,737.80
| Facility | | $144.54 | $144.54 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $213.80
| Professional | | $123.03 | $123.03 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $2,344.23
| Professional | | $1,949.84 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $831.76 / $1,949.84
| Professional | | $398.11 | $831.76 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $12,022.64 / $12,022.64
| Facility | | $100.00 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,071.52 / $2,691.53
| Facility | | $151.36 | $1,071.52 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $213.80
| Professional | | $123.03 | $123.03 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,137.96 / $3,311.31
| Professional | | $1,949.84 | $2,137.96 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $630.96 / $1,122.02
| Facility | | $81.28 | $630.96 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $912.01 / $2,238.72
| Professional | | $741.31 | $912.01 | $2,238.72 |