- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $5,128.61 / $25,118.86
| Facility | | $630.96 | $5,128.61 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $2,691.53 / $5,370.32
| Professional | | $467.74 | $2,691.53 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28,183.83 / $38,904.51 / $38,904.51
| Facility | | $28,183.83 | $38,904.51 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,380.38 / $4,168.69
| Professional | | $457.09 | $1,380.38 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $13,489.63 / $17,782.79
| Professional | | $457.09 | $13,489.63 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,202.26 / $5,495.41
| Professional | | $489.78 | $1,202.26 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $3,019.95 / $3,801.89
| Professional | | $371.54 | $3,019.95 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $7,585.78 / $7,585.78
| Professional | | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $2,570.40 / $6,309.57
| Facility | | $501.19 | $2,570.40 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $630.96 / $26,915.35
| Facility | | $416.87 | $630.96 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,365.16 / $26,915.35
| Professional | | $2,818.38 | $4,365.16 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $19,054.61 / $31,622.78
| Facility | | $10,715.19 | $19,054.61 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,238.72 / $6,025.60
| Professional | | $446.68 | $2,238.72 | $6,025.60 |