- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $6,025.60 / $7,585.78
| Professional | | $4,897.79 | $6,025.60 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $7,762.47 / $7,762.47
| Professional | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $7,413.10
| Professional | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $6,918.31
| Facility | | $4,897.79 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $4,897.79
| Professional | | $4,168.69 | $4,168.69 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $10,232.93 / $12,022.64
| Professional | | $9,120.11 | $10,232.93 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,165.95 / $7,943.28
| Professional | | $6,165.95 | $6,165.95 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $5,888.44 / $10,232.93
| Facility | | $3,311.31 | $5,888.44 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $4,168.69 / $9,549.93
| Facility | | $660.69 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,202.26 / $9,120.11
| Professional | | $660.69 | $1,202.26 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $3,548.13 / $6,606.93
| Facility | | $426.58 | $3,548.13 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,011.87 / $8,317.64
| Professional | | $4,677.35 | $5,011.87 | $8,317.64 |