- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $3,801.89 / $9,772.37
| Facility | | $660.69 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $588.84 / $1,479.11
| Professional | | $436.52 | $588.84 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $10,000.00
| Facility | | $2,630.27 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $562.34 / $1,412.54
| Professional | | $436.52 | $562.34 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,995.26 / $8,912.51
| Facility | | $660.69 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $812.83
| Professional | | $660.69 | $660.69 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,290.87 / $53,703.18
| Facility | | $776.25 | $2,290.87 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $724.44 / $1,778.28
| Professional | | $389.05 | $724.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $512.86 / $1,548.82
| Facility | | $426.58 | $512.86 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $794.33 / $1,202.26
| Professional | | $588.84 | $794.33 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $676.08 / $1,202.26
| Professional | | $398.11 | $676.08 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $50,118.72 / $75,857.76
| Facility | | $436.52 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $691.83 / $1,174.90
| Professional | | $398.11 | $691.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,981.07 / $8,709.64
| Facility | | $2,041.74 | $3,981.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $602.56 / $1,445.44
| Professional | | $398.11 | $602.56 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $630.96 / $1,288.25
| Facility | | $380.19 | $630.96 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $630.96 / $1,445.44
| Professional | | $398.11 | $630.96 | $1,445.44 |