- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $3,090.30 / $10,000.00
| Facility | | $549.54 | $3,090.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $407.38 / $1,174.90
| Professional | | $151.36 | $407.38 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $676.08
| Professional | | $144.54 | $208.93 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,995.26 / $11,220.18
| Facility | | $512.86 | $1,995.26 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $562.34 / $741.31
| Professional | | $162.18 | $562.34 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $524.81 / $1,737.80
| Facility | | $281.84 | $524.81 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $489.78 / $1,148.15
| Professional | | $165.96 | $489.78 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $5,248.07 / $10,471.29
| Facility | | $2,818.38 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $512.86 / $912.01
| Professional | | $338.84 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $125.89 / $912.01
| Professional | | $32.36 | $125.89 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $3,090.30 / $6,760.83
| Facility | | $676.08 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $467.74 / $1,071.52
| Professional | | $151.36 | $467.74 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $512.86 / $707.95
| Professional | | $125.89 | $512.86 | $707.95 |