- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $5,495.41 / $10,964.78
| Facility | | $616.60 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $602.56 / $2,137.96
| Professional | | $489.78 | $602.56 | $2,137.96 |
- 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
- $457.09 / $602.56 / $851.14
| Professional | | $457.09 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $5,011.87 / $6,918.31
| Professional | | $524.81 | $5,011.87 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $602.56 / $912.01
| Professional | | $467.74 | $602.56 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $549.54 / $676.08
| Professional | | $457.09 | $549.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $794.33 / $1,122.02
| Professional | | $645.65 | $794.33 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $1,000.00
| Facility | | $501.19 | $676.08 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $645.65 / $10,000.00
| Facility | | $426.58 | $645.65 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $645.65 / $10,000.00
| Professional | | $426.58 | $645.65 | $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
- $426.58 / $630.96 / $1,023.29
| Professional | | $426.58 | $630.96 | $1,023.29 |