- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $9,549.93 / $25,118.86
| Facility | | $6,025.60 | $9,549.93 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,071.52 / $9,772.37
| Professional | | $302.00 | $1,071.52 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Professional | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15,135.61 / $19,952.62 / $38,904.51
| Facility | | $15,135.61 | $19,952.62 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $3,311.31 / $7,943.28
| Professional | | $346.74 | $3,311.31 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $954.99 / $13,489.63
| Professional | | $676.08 | $954.99 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $6,918.31 / $15,488.17
| Facility | | $426.58 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $10,232.93 / $15,488.17
| Professional | | $6,309.57 | $10,232.93 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $7,762.47 / $13,489.63
| Professional | | $676.08 | $7,762.47 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $8,709.64
| Professional | | $660.69 | $660.69 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $13,489.63 / $17,378.01
| Facility | | $8,317.64 | $13,489.63 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $6,025.60 / $11,748.98
| Professional | | $457.09 | $6,025.60 | $11,748.98 |