- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $11,220.18
| Facility | | $4,786.30 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,890.45 / $6,309.57
| Professional | | $3,090.30 | $3,890.45 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $8,128.31
| Professional | | $6,309.57 | $6,309.57 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $4,073.80
| Professional | | $3,467.37 | $3,467.37 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,762.47 / $15,135.61
| Facility | | $4,073.80 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $8,511.38 / $15,135.61
| Professional | | $4,073.80 | $8,511.38 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $75.86 / $7,413.10
| Professional | | $60.26 | $75.86 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,244.36 / $7,244.36
| Facility | | $7,079.46 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,456.54 / $11,748.98
| Facility | | $6,025.60 | $6,456.54 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $7,079.46
| Professional | | $6,025.60 | $6,025.60 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $8,128.31
| Professional | | $6,309.57 | $6,309.57 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $4,897.79 / $5,011.87
| Facility | | $2,511.89 | $4,897.79 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,365.16 / $6,165.95
| Professional | | $3,090.30 | $4,365.16 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,248.07 / $11,220.18
| Professional | | $3,890.45 | $5,248.07 | $11,220.18 |