- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $6,456.54 / $6,456.54
| Facility | | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,456.54 / $14,125.38
| Professional | | $6,309.57 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $16,595.87 / $23,442.29
| Facility | | $2,344.23 | $16,595.87 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $8,511.38 / $16,218.10
| Professional | | $1,513.56 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $8,317.64 / $8,912.51
| Facility | | $8,317.64 | $8,317.64 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $7,079.46 / $8,317.64
| Professional | | $891.25 | $7,079.46 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $7,762.47 / $14,125.38
| Facility | | $1,122.02 | $7,762.47 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,456.54 / $14,125.38
| Professional | | $6,309.57 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $6,918.31
| Professional | | $501.19 | $676.08 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $8,511.38
| Professional | | $8,128.31 | $8,128.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $7,762.47 / $9,772.37
| Professional | | $7,762.47 | $7,762.47 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $870.96 / $7,413.10
| Facility | | $562.34 | $870.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,466.84 / $7,413.10
| Professional | | $4,265.80 | $4,466.84 | $7,413.10 |