- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,801.89 / $10,000.00
| Facility | | $707.95 | $3,801.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $758.58 / $1,548.82
| Professional | | $467.74 | $758.58 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $11,220.18 / $18,620.87
| Facility | | $4,897.79 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $851.14 / $1,995.26
| Professional | | $691.83 | $851.14 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,995.26 / $8,912.51
| Facility | | $707.95 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $1,202.26
| Professional | | $707.95 | $707.95 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,862.09 / $50,118.72
| Facility | | $870.96 | $1,862.09 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | AS | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,023.29 / $2,754.23
| Professional | | $524.81 | $1,023.29 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $954.99 / $1,862.09
| Facility | | $562.34 | $954.99 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,412.54 / $1,949.84
| Professional | | $933.25 | $1,412.54 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,071.52 / $1,778.28
| Professional | | $602.56 | $1,071.52 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,090.30 / $5,623.41
| Facility | | $2,570.40 | $3,090.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $707.95 / $954.99
| Professional | | $562.34 | $707.95 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $50,118.72 / $75,857.76
| Facility | | $549.54 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,122.02 / $2,238.72
| Professional | | $398.11 | $1,122.02 | $2,238.72 |
- 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
- $489.78 / $977.24 / $2,818.38
| Professional | | $489.78 | $977.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $616.60 / $2,454.71
| Facility | | $416.87 | $616.60 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,000.00 / $1,949.84
| Professional | | $645.65 | $1,000.00 | $1,949.84 |