- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $11,481.54 / $13,489.63
| Professional | | $7,762.47 | $11,481.54 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,803.84 / $13,803.84 / $15,135.61
| Professional | | $13,803.84 | $13,803.84 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $12,589.25 / $12,589.25
| Facility | | $8,128.31 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $9,120.11 / $12,882.50
| Professional | | $9,120.11 | $9,120.11 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $11,481.54 / $12,882.50
| Professional | | $10,715.19 | $11,481.54 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $14,791.08 / $25,703.96
| Facility | | $7,585.78 | $14,791.08 | $25,703.96 |
- 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
- $7,943.28 / $13,182.57 / $14,791.08
| Facility | | $7,943.28 | $13,182.57 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $8,912.51 / $13,489.63
| Professional | | $7,244.36 | $8,912.51 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93,325.43 / $93,325.43 / $93,325.43
| Facility | | $93,325.43 | $93,325.43 | $93,325.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117,489.76 / $117,489.76 / $131,825.67
| Professional | | $117,489.76 | $117,489.76 | $131,825.67 |