- 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
- $8,912.51 / $11,220.18 / $15,848.93
| Professional | | $8,912.51 | $11,220.18 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,877.62 / $21,877.62 / $22,908.68
| Facility | | $21,877.62 | $21,877.62 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $11,748.98 / $24,547.09
| Professional | | $11,748.98 | $11,748.98 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $11,220.18 / $14,791.08
| Professional | | $11,220.18 | $11,220.18 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $13,803.84 / $13,803.84
| Facility | | $9,120.11 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,000.00 / $13,803.84
| Professional | | $10,000.00 | $10,000.00 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16,218.10 / $21,877.62 / $30,199.52
| Professional | | $16,218.10 | $21,877.62 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $14,125.38 / $21,379.62
| Professional | | $11,481.54 | $14,125.38 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $14,791.08 / $24,547.09
| Facility | | $8,317.64 | $14,791.08 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $11,748.98 / $14,125.38
| Professional | | $11,481.54 | $11,748.98 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $16,595.87 / $29,512.09
| Facility | | $10,471.29 | $16,595.87 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $16,595.87 / $29,512.09
| Professional | | $10,471.29 | $16,595.87 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $14,454.40 / $26,302.68
| Facility | | $7,413.10 | $14,454.40 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $10,471.29 / $16,982.44
| Professional | | $9,549.93 | $10,471.29 | $16,982.44 |