- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $6,760.83 / $6,760.83
| Facility | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $9,120.11 / $20,417.38
| Professional | | $6,760.83 | $9,120.11 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $17,378.01 / $19,498.45
| Facility | | $2,951.21 | $17,378.01 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $12,882.50 / $13,489.63
| Professional | | $1,949.84 | $12,882.50 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $11,220.18 / $11,748.98
| Facility | | $11,220.18 | $11,220.18 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $9,549.93 / $11,220.18
| Professional | | $1,288.25 | $9,549.93 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $9,120.11 / $14,125.38
| Facility | | $1,778.28 | $9,120.11 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $9,120.11 / $20,417.38
| Professional | | $6,760.83 | $9,120.11 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $851.14 / $8,709.64
| Professional | | $645.65 | $851.14 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,882.50 / $12,882.50 / $13,489.63
| Professional | | $12,882.50 | $12,882.50 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $12,302.69 / $12,302.69
| Professional | | $9,120.11 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,202.26 / $8,128.31
| Facility | | $616.60 | $1,202.26 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $5,128.61 / $8,128.31
| Professional | | $4,786.30 | $5,128.61 | $8,128.31 |