- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,309.57 / $6,309.57
| Professional | | $3,630.78 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $17,782.79 / $17,782.79
| Facility | | $9,772.37 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $9,772.37 / $12,302.69
| Professional | | $4,677.35 | $9,772.37 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $39,810.72
| Facility | | $3,981.07 | $3,981.07 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $12,022.64 / $19,054.61
| Professional | | $3,388.44 | $12,022.64 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,309.57 / $7,585.78
| Facility | | $3,630.78 | $6,309.57 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $6,456.54 / $7,585.78
| Facility | | $549.54 | $6,456.54 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,162.28 / $5,888.44
| Professional | | $2,511.89 | $3,162.28 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $223.87 / $6,165.95
| Professional | | $31.62 | $223.87 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,862.09 / $2,089.30
| Professional | | $1,096.48 | $1,862.09 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $6,456.54 / $6,456.54
| Facility | | $64.57 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $3,981.07 / $3,981.07
| Professional | | $676.08 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,071.52 / $4,265.80
| Facility | | $323.59 | $1,071.52 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,162.28 / $6,456.54
| Professional | | $2,089.30 | $3,162.28 | $6,456.54 |