- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $5,011.87 / $33,113.11
| Professional | | $2,238.72 | $5,011.87 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $7,585.78 / $7,585.78
| Professional | | $6,918.31 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $4,365.16 / $8,709.64
| Facility | | $4,365.16 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $9,120.11 / $13,489.63
| Professional | | $4,365.16 | $9,120.11 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,709.64 / $33,884.42
| Facility | | $5,011.87 | $8,709.64 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,677.35 / $7,762.47
| Professional | | $2,630.27 | $4,677.35 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $8,511.38 / $20,892.96
| Professional | | $8,511.38 | $8,511.38 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,964.78 / $19,498.45 / $20,892.96
| Professional | | $10,964.78 | $19,498.45 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $5,248.07 / $5,370.32
| Facility | | $3,162.28 | $5,248.07 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,890.45 / $6,165.95
| Professional | | $2,818.38 | $3,890.45 | $6,165.95 |