- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $11,220.18
| Facility | | $4,786.30 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $4,265.80 / $7,762.47
| Professional | | $3,162.28 | $4,265.80 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $7,079.46 / $7,079.46
| Facility | | $6,309.57 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $8,317.64
| Professional | | $6,309.57 | $6,309.57 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $4,677.35
| Professional | | $3,467.37 | $3,467.37 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $10,000.00 / $20,892.96
| Facility | | $4,466.84 | $10,000.00 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $9,120.11 / $16,218.10
| Professional | | $4,466.84 | $9,120.11 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $5,623.41 / $6,165.95
| Professional | | $75.86 | $5,623.41 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,244.36 / $7,413.10
| Facility | | $7,079.46 | $7,244.36 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $10,715.19 / $14,791.08
| Facility | | $6,456.54 | $10,715.19 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $7,079.46
| Professional | | $6,025.60 | $6,025.60 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $8,317.64
| Professional | | $6,309.57 | $6,309.57 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $9,549.93 / $11,481.54
| Facility | | $4,677.35 | $9,549.93 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,677.35 / $6,760.83
| Professional | | $3,311.31 | $4,677.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,248.07 / $11,220.18
| Professional | | $3,630.78 | $5,248.07 | $11,220.18 |