- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $5,495.41 / $10,000.00
| Facility | | $660.69 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $616.60 / $1,258.93
| Professional | | $562.34 | $616.60 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $11,220.18 / $12,302.69
| Facility | | $9,772.37 | $11,220.18 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $1,096.48
| Professional | | $575.44 | $758.58 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $4,786.30 / $8,317.64
| Professional | | $691.83 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $758.58 / $1,258.93
| Professional | | $549.54 | $758.58 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $616.60 / $1,584.89
| Professional | | $512.86 | $616.60 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $954.99 / $1,380.38
| Professional | | $758.58 | $954.99 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $812.83 / $1,174.90
| Facility | | $575.44 | $812.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $776.25 / $10,964.78
| Facility | | $549.54 | $776.25 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $776.25 / $10,964.78
| Professional | | $549.54 | $776.25 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $11,748.98 / $26,302.68
| Facility | | $7,413.10 | $11,748.98 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $1,202.26
| Professional | | $478.63 | $741.31 | $1,202.26 |