- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,791.08 / $15,135.61 / $15,135.61
| Facility | | $14,791.08 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $14,791.08 / $22,387.21
| Professional | | $12,302.69 | $14,791.08 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28,840.32 / $28,840.32 / $30,199.52
| Facility | | $28,840.32 | $28,840.32 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22,387.21 / $22,387.21 / $46,773.51
| Professional | | $22,387.21 | $22,387.21 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,488.17 / $15,488.17 / $19,498.45
| Professional | | $15,488.17 | $15,488.17 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $16,595.87 / $16,595.87
| Facility | | $10,715.19 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,022.64 / $12,022.64 / $12,022.64
| Professional | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $28,840.32 / $39,810.72
| Professional | | $21,379.62 | $28,840.32 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $19,054.61 / $33,113.11
| Facility | | $3,019.95 | $19,054.61 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $15,488.17 / $18,620.87
| Professional | | $478.63 | $15,488.17 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $22,387.21 / $42,657.95
| Facility | | $512.86 | $22,387.21 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $22,387.21 / $42,657.95
| Professional | | $512.86 | $22,387.21 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $19,498.45 / $28,840.32
| Facility | | $489.78 | $19,498.45 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $14,125.38 / $22,387.21
| Professional | | $13,182.57 | $14,125.38 | $22,387.21 |