- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $5,888.44 / $5,888.44
| Facility | | $5,754.40 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $5,888.44 / $8,912.51
| Professional | | $5,128.61 | $5,888.44 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $11,220.18 / $12,022.64
| Facility | | $11,220.18 | $11,220.18 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $6,456.54 / $13,489.63
| Professional | | $6,456.54 | $6,456.54 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $5,888.44 / $7,762.47
| Professional | | $5,888.44 | $5,888.44 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $8,317.64 / $8,317.64
| Facility | | $5,370.32 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $7,413.10
| Professional | | $6,025.60 | $6,025.60 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $11,220.18 / $15,848.93
| Professional | | $8,511.38 | $11,220.18 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $7,413.10 / $10,964.78
| Professional | | $6,918.31 | $7,413.10 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $7,585.78 / $13,489.63
| Facility | | $4,570.88 | $7,585.78 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,244.36 / $7,762.47
| Professional | | $6,025.60 | $7,244.36 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $9,120.11 / $15,135.61
| Facility | | $6,025.60 | $9,120.11 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $9,120.11 / $15,135.61
| Professional | | $6,025.60 | $9,120.11 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,943.28 / $11,220.18
| Facility | | $4,073.80 | $7,943.28 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $5,495.41 / $8,709.64
| Professional | | $5,128.61 | $5,495.41 | $8,709.64 |