- 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
- $3,548.13 / $5,754.40 / $7,943.28
| Professional | | $3,548.13 | $5,754.40 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $8,912.51 / $11,481.54
| Facility | | $1,148.15 | $8,912.51 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $5,370.32 / $8,912.51
| Professional | | $758.58 | $5,370.32 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,370.32
| Facility | | $5,128.61 | $5,128.61 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $4,365.16 / $5,128.61
| Professional | | $562.34 | $4,365.16 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $3,019.95 / $5,888.44
| Facility | | $691.83 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $5,754.40 / $7,943.28
| Professional | | $3,548.13 | $5,754.40 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $5,128.61
| Professional | | $512.86 | $512.86 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,370.32
| Professional | | $5,011.87 | $5,011.87 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,897.79 / $4,897.79
| Professional | | $3,630.78 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $489.78 / $3,311.31
| Facility | | $275.42 | $489.78 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,187.76 / $3,311.31
| Professional | | $2,089.30 | $2,187.76 | $3,311.31 |