- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,125.38 / $14,125.38 / $16,218.10
| Facility | | $14,125.38 | $14,125.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $10,232.93 / $15,488.17
| Professional | | $7,585.78 | $10,232.93 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,589.25 / $12,589.25 / $20,417.38
| Facility | | $12,589.25 | $12,589.25 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,589.25 / $22,387.21 / $28,183.83
| Professional | | $12,589.25 | $22,387.21 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17,378.01 / $19,498.45 / $21,877.62
| Professional | | $17,378.01 | $19,498.45 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $23,442.29 / $91,201.08
| Facility | | $12,302.69 | $23,442.29 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $13,182.57 / $30,199.52
| Professional | | $8,709.64 | $13,182.57 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,952.62 / $20,892.96 / $26,302.68
| Professional | | $19,952.62 | $20,892.96 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,417.38 / $20,417.38 / $20,417.38
| Facility | | $20,417.38 | $20,417.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,952.62 / $30,199.52 / $30,199.52
| Professional | | $19,952.62 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $18,620.87 / $46,773.51
| Facility | | $7,943.28 | $18,620.87 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $9,772.37 / $17,378.01
| Professional | | $8,709.64 | $9,772.37 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14,125.38 / $17,782.79 / $17,782.79
| Professional | | $14,125.38 | $17,782.79 | $17,782.79 |