- 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
- $3,019.95 / $6,456.54 / $41,686.94
| Professional | | $3,019.95 | $6,456.54 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $9,772.37 / $9,772.37
| Professional | | $8,912.51 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $7,585.78 / $11,220.18
| Facility | | $7,585.78 | $7,585.78 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $12,589.25 / $18,197.01
| Professional | | $7,585.78 | $12,589.25 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $10,964.78 / $48,977.88
| Facility | | $6,456.54 | $10,964.78 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $6,165.95 / $10,232.93
| Professional | | $3,388.44 | $6,165.95 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,964.78 / $11,220.18 / $26,915.35
| Professional | | $10,964.78 | $11,220.18 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14,125.38 / $25,118.86 / $26,915.35
| Professional | | $14,125.38 | $25,118.86 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $7,079.46 / $10,964.78
| Facility | | $4,265.80 | $7,079.46 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,011.87 / $7,943.28
| Professional | | $3,630.78 | $5,011.87 | $7,943.28 |