- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $5,128.61 / $8,709.64
| Professional | | $4,466.84 | $5,128.61 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $10,471.29 / $17,378.01
| Facility | | $10,471.29 | $10,471.29 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $9,772.37 / $11,748.98
| Professional | | $9,772.37 | $9,772.37 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $23,988.33 / $51,286.14
| Facility | | $6,606.93 | $23,988.33 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $14,791.08 / $19,952.62
| Professional | | $4,897.79 | $14,791.08 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $8,511.38 / $12,882.50
| Facility | | $5,128.61 | $8,511.38 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $10,000.00 / $12,589.25
| Professional | | $5,888.44 | $10,000.00 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $10,232.93 / $47,863.01
| Facility | | $5,128.61 | $10,232.93 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,606.93 / $11,481.54
| Professional | | $4,677.35 | $6,606.93 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $85.11
| Professional | | $54.95 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $11,748.98 / $20,417.38
| Professional | | $7,413.10 | $11,748.98 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $15,848.93 / $28,840.32
| Professional | | $10,471.29 | $15,848.93 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $20,892.96 / $47,863.01
| Facility | | $6,606.93 | $20,892.96 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $9,772.37 / $51,286.14
| Professional | | $4,897.79 | $9,772.37 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $6,918.31 / $10,471.29
| Facility | | $5,495.41 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $5,128.61 / $8,511.38
| Professional | | $3,981.07 | $5,128.61 | $8,511.38 |