- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $7,079.46 / $8,511.38
| Professional | | $3,890.45 | $7,079.46 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $7,079.46 / $13,489.63
| Facility | | $707.95 | $7,079.46 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $5,754.40 / $8,912.51
| Professional | | $794.33 | $5,754.40 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $5,754.40
| Facility | | $4,786.30 | $4,786.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $4,073.80 / $4,786.30
| Professional | | $616.60 | $4,073.80 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,890.45 / $7,943.28
| Facility | | $758.58 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $7,079.46 / $8,511.38
| Professional | | $3,890.45 | $7,079.46 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $4,168.69 / $5,623.41
| Professional | | $416.87 | $4,168.69 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,495.41 / $5,754.40
| Professional | | $5,495.41 | $5,495.41 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $6,165.95 / $7,943.28
| Professional | | $4,897.79 | $6,165.95 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $3,090.30 / $6,025.60
| Facility | | $323.59 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,890.45 / $6,025.60
| Professional | | $3,548.13 | $3,890.45 | $6,025.60 |