- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $18,197.01 / $21,379.62
| Professional | | $12,302.69 | $18,197.01 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23,988.33 / $23,988.33 / $28,840.32
| Facility | | $23,988.33 | $23,988.33 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22,387.21 / $22,387.21 / $24,547.09
| Professional | | $22,387.21 | $22,387.21 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $16,595.87 / $16,595.87
| Facility | | $269.15 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $12,022.64 / $17,782.79
| Professional | | $478.63 | $12,022.64 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,022.64 / $21,379.62 / $42,657.95
| Facility | | $12,022.64 | $21,379.62 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $19,498.45 / $23,442.29
| Facility | | $10,000.00 | $19,498.45 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,022.64 / $14,454.40 / $20,892.96
| Professional | | $12,022.64 | $14,454.40 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138,038.43 / $138,038.43 / $138,038.43
| Facility | | $138,038.43 | $138,038.43 | $138,038.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147,910.84 / $147,910.84 / $208,929.61
| Professional | | $147,910.84 | $147,910.84 | $208,929.61 |