- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $6,309.57 / $14,125.38
| Professional | | $4,786.30 | $6,309.57 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $12,302.69 / $13,803.84
| Facility | | $2,041.74 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $9,120.11 / $9,549.93
| Professional | | $1,348.96 | $9,120.11 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,248.07
| Facility | | $5,011.87 | $5,011.87 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $4,265.80 / $5,128.61
| Professional | | $891.25 | $4,265.80 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $6,309.57 / $10,471.29
| Facility | | $1,230.27 | $6,309.57 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $6,309.57 / $14,125.38
| Professional | | $4,786.30 | $6,309.57 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $602.56 / $6,165.95
| Professional | | $446.68 | $602.56 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $8,912.51 / $9,549.93
| Professional | | $8,912.51 | $8,912.51 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $8,709.64 / $8,709.64
| Professional | | $6,456.54 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $851.14 / $5,623.41
| Facility | | $426.58 | $851.14 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,630.78 / $5,754.40
| Professional | | $3,311.31 | $3,630.78 | $5,754.40 |