- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $9,549.93 / $13,489.63
| Professional | | $5,011.87 | $9,549.93 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $13,489.63 / $38,904.51
| Professional | | $4,570.88 | $13,489.63 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,467.37 / $5,248.07
| Facility | | $2,137.96 | $3,467.37 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $9,332.54 / $9,332.54
| Professional | | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $9,549.93 / $20,892.96
| Professional | | $9,549.93 | $9,549.93 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,022.64 / $12,022.64 / $14,454.40
| Professional | | $12,022.64 | $12,022.64 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $831.76 / $9,549.93
| Professional | | $630.96 | $831.76 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $12,302.69 / $12,302.69
| Facility | | $100.00 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $11,220.18 / $12,589.25
| Facility | | $6,760.83 | $11,220.18 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $9,549.93 / $11,220.18
| Professional | | $6,165.95 | $9,549.93 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,022.64 / $12,022.64 / $12,302.69
| Professional | | $12,022.64 | $12,022.64 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,023.29 / $6,760.83
| Facility | | $380.19 | $1,023.29 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $5,128.61 / $10,715.19
| Professional | | $3,981.07 | $5,128.61 | $10,715.19 |