- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $8,511.38 / $52,480.75
| Facility | | $4,073.80 | $8,511.38 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,884.03 / $21,877.62
| Professional | | $549.54 | $2,884.03 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15,135.61 / $19,054.61 / $38,904.51
| Facility | | $15,135.61 | $19,054.61 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $6,760.83 / $15,488.17
| Professional | | $630.96 | $6,760.83 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,862.09 / $27,542.29
| Professional | | $1,258.93 | $1,862.09 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $9,772.37 / $19,054.61
| Facility | | $776.25 | $9,772.37 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $19,498.45 / $30,902.95
| Professional | | $11,748.98 | $19,498.45 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $15,488.17 / $27,542.29
| Professional | | $1,202.26 | $15,488.17 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $17,782.79
| Professional | | $1,202.26 | $1,202.26 | $17,782.79 |
- 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
- $831.76 / $11,481.54 / $21,379.62
| Professional | | $831.76 | $11,481.54 | $21,379.62 |