- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $7,079.46 / $25,703.96
| Facility | | $676.08 | $7,079.46 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $5,248.07 / $12,302.69
| Professional | | $512.86 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $8,709.64 / $12,022.64
| Facility | | $6,918.31 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,621.81 / $10,715.19
| Professional | | $489.78 | $1,621.81 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $16,595.87 / $22,387.21
| Professional | | $489.78 | $16,595.87 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,318.26 / $12,882.50
| Professional | | $524.81 | $1,318.26 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $7,943.28 / $9,772.37
| Professional | | $398.11 | $7,943.28 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18,620.87 / $18,620.87 / $18,620.87
| Professional | | $18,620.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $6,165.95 / $13,803.84
| Facility | | $537.03 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $676.08 / $19,952.62
| Facility | | $446.68 | $676.08 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $10,000.00 / $26,915.35
| Professional | | $6,606.93 | $10,000.00 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $16,982.44 / $35,481.34
| Facility | | $9,549.93 | $16,982.44 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $5,011.87 / $14,454.40
| Professional | | $478.63 | $5,011.87 | $14,454.40 |