- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $6,918.31 / $14,791.08
| Facility | | $1,071.52 | $6,918.31 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,630.78 / $8,709.64
| Professional | | $776.25 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $9,120.11 / $9,120.11
| Facility | | $8,128.31 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $2,630.27 / $8,912.51
| Professional | | $812.83 | $2,630.27 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $6,918.31 / $10,000.00
| Professional | | $831.76 | $6,918.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,819.70 / $10,471.29
| Professional | | $794.33 | $1,819.70 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $6,760.83 / $18,197.01
| Professional | | $676.08 | $6,760.83 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $6,760.83 / $15,488.17
| Professional | | $1,513.56 | $6,760.83 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $2,089.30 / $10,964.78
| Facility | | $870.96 | $2,089.30 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,148.15 / $15,135.61
| Facility | | $758.58 | $1,148.15 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $8,317.64 / $19,952.62
| Professional | | $1,412.54 | $8,317.64 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $18,620.87 / $38,904.51
| Facility | | $10,715.19 | $18,620.87 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,621.81 / $10,964.78
| Professional | | $707.95 | $1,621.81 | $10,964.78 |