- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $5,495.41 / $8,511.38
| Professional | | $4,570.88 | $5,495.41 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,964.78 / $10,964.78 / $18,197.01
| Facility | | $10,964.78 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,232.93 / $12,302.69
| Professional | | $10,000.00 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $25,118.86 / $53,703.18
| Facility | | $7,244.36 | $25,118.86 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $15,488.17 / $20,892.96
| Professional | | $5,248.07 | $15,488.17 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $8,912.51 / $13,489.63
| Facility | | $5,370.32 | $8,912.51 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $10,232.93 / $13,182.57
| Professional | | $6,165.95 | $10,232.93 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $10,715.19 / $47,863.01
| Facility | | $5,495.41 | $10,715.19 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $6,606.93 / $12,302.69
| Professional | | $4,570.88 | $6,606.93 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $6,760.83
| Professional | | $54.95 | $70.79 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17,378.01 / $17,378.01 / $17,378.01
| Facility | | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $12,302.69 / $21,379.62
| Professional | | $7,762.47 | $12,302.69 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,964.78 / $16,595.87 / $28,840.32
| Professional | | $10,964.78 | $16,595.87 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $21,877.62 / $48,977.88
| Facility | | $7,244.36 | $21,877.62 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $10,715.19 / $52,480.75
| Professional | | $5,248.07 | $10,715.19 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $6,918.31 / $10,964.78
| Facility | | $5,128.61 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,370.32 / $8,912.51
| Professional | | $3,890.45 | $5,370.32 | $8,912.51 |