- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $10,232.93 / $14,125.38
| Professional | | $8,128.31 | $10,232.93 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $19,498.45 / $20,892.96
| Facility | | $19,498.45 | $19,498.45 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $10,715.19 / $22,387.21
| Professional | | $10,715.19 | $10,715.19 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $11,220.18 / $13,489.63
| Professional | | $11,220.18 | $11,220.18 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $12,589.25 / $12,589.25
| Facility | | $8,128.31 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $9,120.11 / $12,589.25
| Professional | | $9,120.11 | $9,120.11 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14,791.08 / $19,498.45 / $27,542.29
| Professional | | $14,791.08 | $19,498.45 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $12,882.50 / $19,054.61
| Professional | | $11,481.54 | $12,882.50 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $13,489.63 / $22,387.21
| Facility | | $7,585.78 | $13,489.63 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $10,471.29 / $12,882.50
| Professional | | $10,471.29 | $10,471.29 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $14,791.08 / $26,915.35
| Facility | | $10,000.00 | $14,791.08 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $14,791.08 / $26,915.35
| Professional | | $10,000.00 | $14,791.08 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $13,182.57 / $19,498.45
| Facility | | $6,760.83 | $13,182.57 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $9,549.93 / $15,135.61
| Professional | | $8,709.64 | $9,549.93 | $15,135.61 |