- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $10,964.78 / $77,624.71
| Professional | | $5,495.41 | $10,964.78 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,135.61 / $16,595.87 / $16,982.44
| Professional | | $15,135.61 | $16,595.87 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $11,748.98 / $19,498.45
| Facility | | $11,748.98 | $11,748.98 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $20,892.96 / $32,359.37
| Professional | | $11,748.98 | $20,892.96 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,964.78 / $19,498.45 / $87,096.36
| Facility | | $10,964.78 | $19,498.45 | $87,096.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $10,715.19 / $17,378.01
| Professional | | $5,754.40 | $10,715.19 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,054.61 / $19,054.61 / $46,773.51
| Professional | | $19,054.61 | $19,054.61 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $19,498.45 / $19,498.45
| Facility | | $19,498.45 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23,988.33 / $42,657.95 / $46,773.51
| Professional | | $23,988.33 | $42,657.95 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $12,882.50 / $19,498.45
| Facility | | $7,585.78 | $12,882.50 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $8,511.38 / $13,489.63
| Professional | | $6,165.95 | $8,511.38 | $13,489.63 |