- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,128.61 / $8,511.38
| Professional | | $4,265.80 | $5,128.61 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $10,232.93 / $16,982.44
| Facility | | $10,232.93 | $10,232.93 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $9,549.93 / $11,481.54
| Professional | | $9,332.54 | $9,549.93 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $23,988.33 / $51,286.14
| Facility | | $6,606.93 | $23,988.33 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $14,791.08 / $19,498.45
| Professional | | $4,786.30 | $14,791.08 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,317.64 / $12,882.50
| Facility | | $5,011.87 | $8,317.64 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $9,332.54 / $12,302.69
| Professional | | $5,754.40 | $9,332.54 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $10,232.93 / $46,773.51
| Facility | | $5,128.61 | $10,232.93 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $6,456.54 / $11,481.54
| Professional | | $4,570.88 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $4,786.30
| Professional | | $54.95 | $70.79 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16,218.10 / $16,218.10 / $16,218.10
| Facility | | $16,218.10 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $11,748.98 / $20,417.38
| Professional | | $7,244.36 | $11,748.98 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $15,488.17 / $28,183.83
| Professional | | $10,232.93 | $15,488.17 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $20,417.38 / $46,773.51
| Facility | | $6,606.93 | $20,417.38 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $9,549.93 / $60,255.96
| Professional | | $4,786.30 | $9,549.93 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,760.83 / $10,232.93
| Facility | | $4,677.35 | $6,760.83 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $5,011.87 / $8,511.38
| Professional | | $3,801.89 | $5,011.87 | $8,511.38 |