- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,011.87 / $12,022.64
| Professional | | $4,265.80 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $10,471.29 / $18,620.87
| Facility | | $1,862.09 | $10,471.29 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $7,943.28 / $12,882.50
| Professional | | $1,230.27 | $7,943.28 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $7,585.78 / $7,943.28
| Facility | | $7,585.78 | $7,585.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $6,456.54 / $7,585.78
| Professional | | $812.83 | $6,456.54 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $6,025.60 / $9,120.11
| Facility | | $1,096.48 | $6,025.60 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,011.87 / $12,022.64
| Professional | | $4,265.80 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $5,495.41
| Professional | | $407.38 | $537.03 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $7,585.78 / $7,943.28
| Professional | | $7,585.78 | $7,585.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,244.36 / $7,762.47
| Professional | | $6,025.60 | $7,244.36 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $741.31 / $5,888.44
| Facility | | $457.09 | $741.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,467.37 / $5,623.41
| Professional | | $3,019.95 | $3,467.37 | $5,623.41 |