- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $7,943.28 / $8,709.64
| Facility | | $588.84 | $7,943.28 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $8,511.38 / $8,912.51
| Professional | | $7,943.28 | $8,511.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $9,332.54 / $10,232.93
| Professional | | $6,918.31 | $9,332.54 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $14,454.40 / $21,379.62
| Facility | | $8,317.64 | $14,454.40 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $8,912.51 / $8,912.51
| Professional | | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Professional | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $8,511.38 / $11,220.18
| Facility | | $426.58 | $8,511.38 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $16,595.87 / $18,620.87
| Facility | | $12,302.69 | $16,595.87 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $8,912.51 / $9,772.37
| Professional | | $8,317.64 | $8,912.51 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34,673.69 / $34,673.69 / $34,673.69
| Facility | | $34,673.69 | $34,673.69 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47,863.01 / $47,863.01 / $47,863.01
| Professional | | $47,863.01 | $47,863.01 | $47,863.01 |