- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,511.89 / $10,000.00
| Facility | | $489.78 | $2,511.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $724.44 / $1,698.24
| Professional | | $186.21 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $257.04 / $676.08
| Professional | | $34.67 | $257.04 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,897.79 / $13,182.57
| Facility | | $4,073.80 | $4,897.79 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,000.00 / $1,230.27
| Professional | | $724.44 | $1,000.00 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $9,772.37 / $10,000.00
| Facility | | $3,090.30 | $9,772.37 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $870.96 / $1,318.26
| Professional | | $562.34 | $870.96 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,023.29 / $4,786.30
| Professional | | $645.65 | $1,023.29 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $758.58 / $831.76
| Professional | | $707.95 | $758.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $645.65
| Professional | | $32.36 | $33.11 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $6,309.57 / $13,182.57
| Facility | | $2,818.38 | $6,309.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $794.33 / $1,862.09
| Professional | | $524.81 | $794.33 | $1,862.09 |