- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,548.13 / $10,232.93
| Facility | | $954.99 | $3,548.13 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $831.76 / $2,187.76
| Professional | | $645.65 | $831.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $10,000.00
| Facility | | $2,630.27 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $912.01 / $1,995.26
| Professional | | $707.95 | $912.01 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,995.26 / $8,912.51
| Facility | | $1,047.13 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,230.27
| Professional | | $1,047.13 | $1,047.13 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $4,786.30 / $53,703.18
| Facility | | $1,230.27 | $4,786.30 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,096.48 / $2,570.40
| Professional | | $549.54 | $1,096.48 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $794.33 / $2,454.71
| Facility | | $616.60 | $794.33 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,230.27 / $1,949.84
| Professional | | $891.25 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $954.99 / $1,621.81
| Professional | | $707.95 | $954.99 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $50,118.72 / $75,857.76
| Facility | | $776.25 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,071.52 / $1,348.96
| Professional | | $398.11 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,467.37 / $7,244.36
| Facility | | $2,089.30 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $954.99 / $2,290.87
| Professional | | $501.19 | $954.99 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $794.33 / $2,570.40
| Facility | | $602.56 | $794.33 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,000.00 / $2,187.76
| Professional | | $707.95 | $1,000.00 | $2,187.76 |