- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $3,801.89 / $10,000.00
| Facility | | $489.78 | $3,801.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $501.19 / $1,071.52
| Professional | | $323.59 | $501.19 | $1,071.52 |
- 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
- $371.54 / $478.63 / $1,202.26
| Professional | | $371.54 | $478.63 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,995.26 / $8,912.51
| Facility | | $489.78 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $691.83
| Professional | | $489.78 | $489.78 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,862.09 / $50,118.72
| Facility | | $602.56 | $1,862.09 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $645.65 / $1,659.59
| Professional | | $363.08 | $645.65 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $380.19 / $933.25
| Facility | | $223.87 | $380.19 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $794.33 / $1,096.48
| Professional | | $524.81 | $794.33 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $630.96 / $1,023.29
| Professional | | $389.05 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $501.19 / $891.25
| Professional | | $446.68 | $501.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $50,118.72 / $75,857.76
| Facility | | $354.81 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $645.65 / $1,288.25
| Professional | | $398.11 | $645.65 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,467.37 / $7,943.28
| Facility | | $1,862.09 | $3,467.37 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $575.44 / $1,659.59
| Professional | | $331.13 | $575.44 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $1,584.89
| Facility | | $288.40 | $416.87 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $602.56 / $1,258.93
| Professional | | $389.05 | $602.56 | $1,258.93 |