- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,882.50 / $12,882.50 / $12,882.50
| Facility | | $12,882.50 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $10,964.78 / $12,882.50
| Professional | | $7,413.10 | $10,964.78 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,454.40 / $14,454.40 / $16,982.44
| Facility | | $14,454.40 | $14,454.40 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $13,182.57 / $14,454.40
| Professional | | $13,182.57 | $13,182.57 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $11,748.98 / $11,748.98
| Facility | | $7,762.47 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $8,511.38 / $12,589.25
| Professional | | $8,511.38 | $8,511.38 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $11,481.54 / $12,022.64
| Professional | | $10,471.29 | $11,481.54 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $14,125.38 / $24,547.09
| Facility | | $7,244.36 | $14,125.38 | $24,547.09 |
- 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
- $7,585.78 / $12,882.50 / $14,125.38
| Facility | | $7,585.78 | $12,882.50 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $8,709.64 / $13,182.57
| Professional | | $7,079.46 | $8,709.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89,125.09 / $89,125.09 / $89,125.09
| Facility | | $89,125.09 | $89,125.09 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114,815.36 / $114,815.36 / $128,824.96
| Professional | | $114,815.36 | $114,815.36 | $128,824.96 |