- 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
- $4,168.69 / $4,265.80 / $9,332.54
| Professional | | $4,168.69 | $4,265.80 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $10,964.78 / $15,135.61
| Facility | | $1,513.56 | $10,964.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $5,623.41 / $10,471.29
| Professional | | $1,000.00 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,495.41 / $5,754.40
| Facility | | $5,495.41 | $5,495.41 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $4,677.35 / $5,495.41
| Professional | | $588.84 | $4,677.35 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $5,128.61 / $9,332.54
| Facility | | $724.44 | $5,128.61 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,265.80 / $9,332.54
| Professional | | $4,168.69 | $4,265.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $4,466.84
| Professional | | $331.13 | $446.68 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $5,370.32 / $5,623.41
| Professional | | $5,370.32 | $5,370.32 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $6,456.54
| Professional | | $5,128.61 | $5,128.61 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $562.34 / $4,897.79
| Facility | | $363.08 | $562.34 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,951.21 / $4,897.79
| Professional | | $2,754.23 | $2,951.21 | $4,897.79 |