- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $9,549.93 / $66,069.34
| Professional | | $4,677.35 | $9,549.93 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $14,454.40 / $14,454.40
| Professional | | $13,182.57 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,000.00 / $16,595.87
| Facility | | $10,000.00 | $10,000.00 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $17,782.79 / $27,542.29
| Professional | | $10,000.00 | $17,782.79 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $16,218.10 / $75,857.76
| Facility | | $9,549.93 | $16,218.10 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $9,120.11 / $15,135.61
| Professional | | $4,897.79 | $9,120.11 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16,218.10 / $16,218.10 / $39,810.72
| Professional | | $16,218.10 | $16,218.10 | $39,810.72 |
- 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
- $20,417.38 / $37,153.52 / $39,810.72
| Professional | | $20,417.38 | $37,153.52 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $10,964.78 / $16,595.87
| Facility | | $6,606.93 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $7,413.10 / $11,748.98
| Professional | | $5,370.32 | $7,413.10 | $11,748.98 |