- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $3,311.31 / $10,000.00
| Facility | | $741.31 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $794.33 / $1,258.93
| Professional | | $630.96 | $794.33 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Professional | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $2,137.96 / $11,220.18
| Facility | | $933.25 | $2,137.96 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $794.33 / $977.24
| Professional | | $691.83 | $794.33 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $977.24 / $1,230.27
| Facility | | $489.78 | $977.24 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $851.14 / $1,479.11
| Professional | | $616.60 | $851.14 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,309.57 / $11,748.98
| Facility | | $3,548.13 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $676.08 / $1,000.00
| Professional | | $616.60 | $676.08 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $707.95 / $1,288.25
| Professional | | $32.36 | $707.95 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,311.31 / $6,918.31
| Facility | | $1,000.00 | $3,311.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $794.33 / $1,445.44
| Professional | | $588.84 | $794.33 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $660.69 / $912.01
| Professional | | $562.34 | $660.69 | $912.01 |