- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $4,365.16 / $8,912.51
| Facility | | $660.69 | $4,365.16 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,230.27 / $2,290.87
| Professional | | $398.11 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $8,709.64 / $12,022.64
| Facility | | $6,918.31 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,000.00 / $1,905.46
| Professional | | $407.38 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $3,890.45 / $5,495.41
| Professional | | $416.87 | $3,890.45 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $977.24 / $2,187.76
| Professional | | $398.11 | $977.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,584.89 / $1,949.84
| Professional | | $346.74 | $1,584.89 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,089.30 / $3,162.28
| Professional | | $1,659.59 | $2,089.30 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,288.25 / $2,398.83
| Facility | | $426.58 | $1,288.25 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $10,000.00
| Facility | | $346.74 | $512.86 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,778.28 / $10,000.00
| Professional | | $1,174.90 | $1,778.28 | $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
- $363.08 / $977.24 / $2,398.83
| Professional | | $363.08 | $977.24 | $2,398.83 |