- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $4,466.84 / $30,199.52
| Professional | | $1,698.24 | $4,466.84 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,760.83 / $6,760.83
| Professional | | $6,025.60 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $7,762.47
| Facility | | $3,715.35 | $3,715.35 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $7,585.78 / $11,748.98
| Professional | | $3,715.35 | $7,585.78 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $7,585.78 / $27,542.29
| Facility | | $3,981.07 | $7,585.78 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,467.37 / $6,918.31
| Professional | | $2,290.87 | $3,467.37 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $7,585.78 / $18,620.87
| Professional | | $7,585.78 | $7,585.78 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $17,378.01 / $18,620.87
| Professional | | $9,549.93 | $17,378.01 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,890.45 / $6,025.60
| Facility | | $3,467.37 | $3,890.45 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,467.37 / $5,370.32
| Professional | | $2,344.23 | $3,467.37 | $5,370.32 |