- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $4,265.80 / $10,000.00
| Facility | | $954.99 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $776.25 / $1,905.46
| Professional | | $630.96 | $776.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,495.41 / $12,882.50
| Facility | | $3,388.44 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $1,698.24
| Professional | | $575.44 | $724.44 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,995.26 / $8,912.51
| Facility | | $1,000.00 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,862.09 / $50,118.72
| Facility | | $1,202.26 | $1,862.09 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,071.52 / $3,162.28
| Professional | | $691.83 | $1,071.52 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $2,570.40
| Facility | | $724.44 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $1,548.82
| Professional | | $724.44 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $933.25 / $1,479.11
| Professional | | $562.34 | $933.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $50,118.72 / $75,857.76
| Facility | | $691.83 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $912.01 / $1,905.46
| Professional | | $398.11 | $912.01 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,897.79 / $11,481.54
| Facility | | $2,344.23 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $954.99 / $2,951.21
| Professional | | $630.96 | $954.99 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $851.14 / $3,019.95
| Facility | | $575.44 | $851.14 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $870.96 / $1,995.26
| Professional | | $562.34 | $870.96 | $1,995.26 |