- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $3,715.35 / $10,000.00
| Facility | | $741.31 | $3,715.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $457.09 / $912.01
| Professional | | $257.04 | $457.09 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $436.52 / $645.65
| Professional | | $426.58 | $436.52 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,187.76 / $12,302.69
| Facility | | $776.25 | $2,187.76 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $501.19
| Professional | | $275.42 | $380.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $954.99 / $1,148.15
| Facility | | $436.52 | $954.99 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $457.09 / $831.76
| Professional | | $269.15 | $457.09 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,309.57 / $11,748.98
| Facility | | $3,548.13 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $346.74 / $588.84
| Professional | | $323.59 | $346.74 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $549.54
| Professional | | $32.36 | $33.11 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $5,495.41 / $9,772.37
| Facility | | $1,698.24 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $812.83
| Professional | | $251.19 | $446.68 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $346.74 / $478.63
| Professional | | $208.93 | $346.74 | $478.63 |