- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $7,413.10 / $10,471.29
| Professional | | $4,677.35 | $7,413.10 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $10,964.78 / $16,982.44
| Facility | | $1,698.24 | $10,964.78 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $6,760.83 / $11,748.98
| Professional | | $1,122.02 | $6,760.83 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $6,456.54 / $6,760.83
| Facility | | $6,456.54 | $6,456.54 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $5,495.41 / $6,456.54
| Professional | | $691.83 | $5,495.41 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $5,623.41 / $10,471.29
| Facility | | $912.01 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $7,413.10 / $10,471.29
| Professional | | $4,677.35 | $7,413.10 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $489.78 / $5,011.87
| Professional | | $371.54 | $489.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $6,760.83
| Professional | | $6,309.57 | $6,309.57 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $6,165.95 / $7,079.46
| Professional | | $5,888.44 | $6,165.95 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $588.84 / $5,370.32
| Facility | | $416.87 | $588.84 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,090.30 / $5,370.32
| Professional | | $2,818.38 | $3,090.30 | $5,370.32 |