- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $9,772.37 / $15,848.93
| Professional | | $5,011.87 | $9,772.37 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $8,128.31 / $14,791.08
| Professional | | $7,079.46 | $8,128.31 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $17,782.79
| Facility | | $1,380.38 | $1,380.38 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $17,782.79
| Professional | | $1,380.38 | $1,380.38 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $8,511.38 / $10,000.00
| Professional | | $1,230.27 | $8,511.38 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $9,120.11 / $9,120.11
| Professional | | $7,413.10 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $9,120.11 / $9,120.11
| Facility | | $9,120.11 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $7,943.28 / $9,120.11
| Professional | | $7,943.28 | $7,943.28 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,659.59 / $6,918.31
| Facility | | $524.81 | $1,659.59 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $5,495.41 / $8,912.51
| Professional | | $70.79 | $5,495.41 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $7,943.28 / $9,120.11
| Facility | | $7,762.47 | $7,943.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $7,943.28 / $9,120.11
| Professional | | $7,943.28 | $7,943.28 | $9,120.11 |