- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,630.78 / $10,000.00
| Facility | | $776.25 | $3,630.78 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $707.95 / $1,174.90
| Professional | | $537.03 | $707.95 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $891.25 / $1,318.26
| Professional | | $630.96 | $891.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $933.25 / $4,365.16
| Professional | | $660.69 | $933.25 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $831.76 / $1,445.44
| Professional | | $588.84 | $831.76 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $954.99 / $2,511.89
| Professional | | $537.03 | $954.99 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,148.15 / $1,737.80
| Professional | | $912.01 | $1,148.15 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $870.96 / $1,380.38
| Facility | | $616.60 | $870.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $794.33 / $10,000.00
| Facility | | $537.03 | $794.33 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,000.00 / $10,000.00
| Professional | | $676.08 | $1,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $8,317.64 / $17,378.01
| Facility | | $5,495.41 | $8,317.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $812.83 / $1,412.54
| Professional | | $512.86 | $812.83 | $1,412.54 |