- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,388.44 / $4,786.30
| Professional | | $2,511.89 | $3,388.44 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,370.32 / $10,232.93
| Facility | | $4,677.35 | $5,370.32 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,309.57 / $6,309.57
| Professional | | $6,025.60 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,570.88 / $4,786.30
| Facility | | $3,548.13 | $4,570.88 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $4,570.88
| Professional | | $3,890.45 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $5,370.32 / $6,025.60
| Facility | | $1,659.59 | $5,370.32 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,128.61 / $5,754.40
| Professional | | $3,388.44 | $5,128.61 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $4,897.79
| Professional | | $30.20 | $30.20 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $6,025.60
| Professional | | $3,981.07 | $3,981.07 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $5,754.40 / $5,888.44
| Professional | | $4,466.84 | $5,754.40 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,890.45 / $3,981.07
| Facility | | $3,388.44 | $3,890.45 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,570.40 / $3,981.07
| Professional | | $2,344.23 | $2,570.40 | $3,981.07 |