- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,370.32 / $12,589.25
| Professional | | $4,677.35 | $5,370.32 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $12,022.64 / $19,952.62
| Facility | | $1,995.26 | $12,022.64 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $8,317.64 / $13,803.84
| Professional | | $1,288.25 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $7,943.28 / $8,317.64
| Facility | | $7,943.28 | $7,943.28 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $6,606.93 / $7,943.28
| Professional | | $812.83 | $6,606.93 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $6,309.57 / $9,549.93
| Facility | | $1,122.02 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,370.32 / $12,589.25
| Professional | | $4,677.35 | $5,370.32 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $575.44 / $5,888.44
| Professional | | $426.58 | $575.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $7,762.47 / $8,317.64
| Professional | | $7,762.47 | $7,762.47 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $7,585.78 / $8,317.64
| Professional | | $6,606.93 | $7,585.78 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $794.33 / $6,309.57
| Facility | | $478.63 | $794.33 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,801.89 / $6,309.57
| Professional | | $3,235.94 | $3,801.89 | $6,309.57 |