- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $6,918.31 / $26,302.68
| Facility | | $977.24 | $6,918.31 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $3,235.94 / $14,454.40
| Professional | | $588.84 | $3,235.94 | $14,454.40 |
- 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
- $575.44 / $1,905.46 / $12,882.50
| Professional | | $575.44 | $1,905.46 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $16,595.87 / $22,387.21
| Professional | | $575.44 | $16,595.87 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,548.82 / $16,218.10
| Professional | | $630.96 | $1,548.82 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $9,332.54 / $11,748.98
| Professional | | $467.74 | $9,332.54 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22,908.68 / $22,908.68 / $22,908.68
| Professional | | $22,908.68 | $22,908.68 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $7,943.28 / $17,378.01
| Facility | | $645.65 | $7,943.28 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $812.83 / $19,952.62
| Facility | | $524.81 | $812.83 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $12,302.69 / $30,199.52
| Professional | | $8,317.64 | $12,302.69 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $16,982.44 / $31,622.78
| Facility | | $9,549.93 | $16,982.44 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $6,456.54 / $18,197.01
| Professional | | $562.34 | $6,456.54 | $18,197.01 |