- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $8,511.38 / $33,113.11
| Facility | | $5,754.40 | $8,511.38 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $2,187.76 / $11,481.54
| Professional | | $478.63 | $2,187.76 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $478.63 / $3,801.89
| Professional | | $338.84 | $478.63 | $3,801.89 |
- 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
- $467.74 / $3,630.78 / $8,709.64
| Professional | | $467.74 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $8,317.64 / $13,803.84
| Professional | | $933.25 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $6,918.31 / $15,488.17
| Facility | | $575.44 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $9,332.54 / $16,982.44
| Professional | | $6,025.60 | $9,332.54 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $8,317.64 / $13,803.84
| Professional | | $912.01 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $9,549.93
| Professional | | $891.25 | $891.25 | $9,549.93 |
- 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
- $616.60 / $5,754.40 / $11,220.18
| Professional | | $616.60 | $5,754.40 | $11,220.18 |