- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $5,888.44 / $10,964.78
| Facility | | $630.96 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $630.96 / $1,445.44
| Professional | | $489.78 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $741.31 / $1,071.52
| Professional | | $562.34 | $741.31 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $5,248.07 / $8,317.64
| Professional | | $645.65 | $5,248.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $724.44 / $1,230.27
| Professional | | $501.19 | $724.44 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $602.56 / $1,584.89
| Professional | | $501.19 | $602.56 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,380.38
| Professional | | $724.44 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $776.25 / $1,122.02
| Facility | | $501.19 | $776.25 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $776.25 / $10,000.00
| Facility | | $512.86 | $776.25 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $776.25 / $10,000.00
| Professional | | $512.86 | $776.25 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $10,471.29 / $21,379.62
| Facility | | $6,456.54 | $10,471.29 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $724.44 / $1,148.15
| Professional | | $478.63 | $724.44 | $1,148.15 |