- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,248.07 / $7,585.78
| Professional | | $3,388.44 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $6,165.95 / $10,964.78
| Facility | | $616.60 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $5,011.87 / $7,244.36
| Professional | | $691.83 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $4,365.16
| Facility | | $2,884.03 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $2,454.71 / $3,019.95
| Professional | | $478.63 | $2,454.71 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $2,951.21 / $5,248.07
| Facility | | $660.69 | $2,951.21 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,248.07 / $7,585.78
| Professional | | $3,388.44 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $3,630.78 / $4,897.79
| Professional | | $371.54 | $3,630.78 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $5,011.87
| Professional | | $4,786.30 | $4,786.30 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $6,918.31 / $6,918.31
| Professional | | $5,128.61 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $2,290.87 / $4,570.88
| Facility | | $229.09 | $2,290.87 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,884.03 / $4,570.88
| Professional | | $2,691.53 | $2,884.03 | $4,570.88 |