- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $9,332.54 / $10,964.78
| Professional | | $4,897.79 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $9,120.11 / $17,782.79
| Facility | | $912.01 | $9,120.11 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $7,244.36 / $11,748.98
| Professional | | $1,023.29 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $5,888.44 / $7,943.28
| Facility | | $5,888.44 | $5,888.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $5,011.87 / $6,025.60
| Professional | | $758.58 | $5,011.87 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $4,786.30 / $9,332.54
| Facility | | $954.99 | $4,786.30 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $9,332.54 / $10,964.78
| Professional | | $4,897.79 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $5,370.32 / $7,244.36
| Professional | | $549.54 | $5,370.32 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $7,244.36
| Professional | | $6,918.31 | $6,918.31 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $10,000.00 / $10,471.29
| Professional | | $8,317.64 | $10,000.00 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $4,168.69 / $7,762.47
| Facility | | $426.58 | $4,168.69 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $5,128.61 / $7,762.47
| Professional | | $4,786.30 | $5,128.61 | $7,762.47 |