- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $6,025.60 / $6,456.54
| Professional | | $5,754.40 | $6,025.60 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $7,244.36 / $7,413.10
| Facility | | $6,165.95 | $7,244.36 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $6,606.93 / $6,606.93
| Professional | | $758.58 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,265.80 / $11,220.18
| Facility | | $2,238.72 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $6,760.83
| Professional | | $1,412.54 | $2,238.72 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $6,025.60 / $7,244.36
| Facility | | $831.76 | $6,025.60 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $2,754.23 / $3,630.78
| Professional | | $831.76 | $2,754.23 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $6,025.60 / $7,585.78
| Facility | | $831.76 | $6,025.60 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,760.83 / $25,118.86
| Professional | | $6,025.60 | $6,760.83 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $60.26 / $70.79
| Professional | | $54.95 | $60.26 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,168.69 / $4,168.69
| Facility | | $3,890.45 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,479.11 / $14,791.08
| Professional | | $912.01 | $1,479.11 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,584.89 / $2,570.40
| Professional | | $891.25 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $11,748.98 / $26,302.68
| Facility | | $6,165.95 | $11,748.98 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,165.95 / $32,359.37
| Professional | | $6,165.95 | $6,165.95 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $2,454.71
| Professional | | $1,348.96 | $1,348.96 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $5,248.07 / $12,302.69
| Facility | | $3,311.31 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,606.93 / $7,413.10
| Professional | | $6,025.60 | $6,606.93 | $7,413.10 |