- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $4,265.80 / $10,000.00
| Facility | | $1,122.02 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,023.29 / $2,630.27
| Professional | | $741.31 | $1,023.29 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $9,772.37
| Facility | | $2,630.27 | $4,786.30 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $831.76 / $2,041.74
| Professional | | $660.69 | $831.76 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,995.26 / $8,912.51
| Facility | | $1,122.02 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $4,786.30 / $53,703.18
| Facility | | $1,348.96 | $4,786.30 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,412.54 / $3,630.78
| Professional | | $588.84 | $1,412.54 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,148.15 / $2,754.23
| Facility | | $851.14 | $1,148.15 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $1,513.56
| Professional | | $758.58 | $1,023.29 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,096.48 / $1,698.24
| Professional | | $660.69 | $1,096.48 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $50,118.72 / $75,857.76
| Facility | | $891.25 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,071.52 / $1,737.80
| Professional | | $398.11 | $1,071.52 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $4,786.30 / $10,000.00
| Facility | | $2,398.83 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,071.52 / $2,570.40
| Professional | | $616.60 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,071.52 / $2,691.53
| Facility | | $645.65 | $1,071.52 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,071.52 / $2,454.71
| Professional | | $645.65 | $1,071.52 | $2,454.71 |