- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,311.31 / $7,079.46
| Professional | | $3,162.28 | $3,311.31 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $8,317.64 / $11,748.98
| Facility | | $1,174.90 | $8,317.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $4,168.69 / $8,128.31
| Professional | | $758.58 | $4,168.69 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $4,365.16
| Facility | | $4,168.69 | $4,168.69 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $3,467.37 / $4,168.69
| Professional | | $436.52 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $3,801.89 / $7,079.46
| Facility | | $549.54 | $3,801.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,311.31 / $7,079.46
| Professional | | $3,162.28 | $3,311.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $3,467.37
| Professional | | $257.04 | $338.84 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $4,168.69
| Professional | | $3,981.07 | $3,981.07 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $4,897.79
| Professional | | $3,801.89 | $3,801.89 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $426.58 / $3,715.35
| Facility | | $281.84 | $426.58 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,290.87 / $3,715.35
| Professional | | $2,089.30 | $2,290.87 | $3,715.35 |