- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $6,309.57 / $8,709.64
| Facility | | $1,000.00 | $6,309.57 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,230.27 / $2,570.40
| Professional | | $1,000.00 | $1,230.27 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,041.74 / $3,162.28
| Professional | | $1,445.44 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,388.44 / $9,120.11
| Professional | | $2,089.30 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,511.89 / $3,981.07
| Facility | | $524.81 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $851.14 / $1,348.96
| Professional | | $501.19 | $851.14 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,786.30 / $4,786.30
| Professional | | $3,630.78 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,513.56 / $2,137.96
| Facility | | $1,000.00 | $1,513.56 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $194.98 / $1,445.44
| Facility | | $100.00 | $194.98 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $186.21 / $10,000.00
| Professional | | $91.20 | $186.21 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $3,548.13 / $6,165.95
| Facility | | $134.90 | $3,548.13 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,801.89 / $5,888.44
| Professional | | $2,238.72 | $3,801.89 | $5,888.44 |