- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $6,025.60 / $10,000.00
| Facility | | $323.59 | $6,025.60 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $2,511.89 / $6,025.60
| Professional | | $323.59 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,511.89 / $7,413.10
| Facility | | $2,290.87 | $2,511.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $15,488.17
| Professional | | $1,862.09 | $1,862.09 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $6,165.95 / $8,912.51
| Facility | | $4,897.79 | $6,165.95 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $2,884.03
| Professional | | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,570.40 / $6,025.60
| Facility | | $2,041.74 | $2,570.40 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,311.31 / $8,128.31
| Professional | | $1,819.70 | $3,311.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $5,248.07 / $9,772.37
| Facility | | $83.18 | $5,248.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $5,248.07
| Professional | | $4,466.84 | $4,466.84 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $5,248.07
| Professional | | $3,090.30 | $3,090.30 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,511.89 / $7,413.10
| Facility | | $2,290.87 | $2,511.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $15,488.17
| Professional | | $1,862.09 | $1,862.09 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,090.30 / $3,715.35
| Facility | | $1,862.09 | $3,090.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,090.30 / $5,888.44
| Professional | | $1,862.09 | $3,090.30 | $5,888.44 |