- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $4,265.80 / $10,000.00
| Facility | | $933.25 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $851.14 / $2,187.76
| Professional | | $616.60 | $851.14 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $11,481.54 / $26,302.68
| Facility | | $5,128.61 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $676.08 / $1,659.59
| Professional | | $537.03 | $676.08 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,995.26 / $8,912.51
| Facility | | $933.25 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Professional | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $4,786.30 / $53,703.18
| Facility | | $1,122.02 | $4,786.30 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,148.15 / $3,019.95
| Professional | | $489.78 | $1,148.15 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,122.02 / $2,344.23
| Facility | | $724.44 | $1,122.02 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $870.96 / $1,288.25
| Professional | | $645.65 | $870.96 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $891.25 / $1,659.59
| Professional | | $537.03 | $891.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $50,118.72 / $75,857.76
| Facility | | $724.44 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $870.96 / $1,445.44
| Professional | | $398.11 | $870.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $7,244.36 / $27,542.29
| Facility | | $2,754.23 | $7,244.36 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $891.25 / $2,137.96
| Professional | | $501.19 | $891.25 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $891.25 / $2,187.76
| Facility | | $549.54 | $891.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $891.25 / $1,995.26
| Professional | | $537.03 | $891.25 | $1,995.26 |