- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $11,481.54 / $81,283.05
| Professional | | $5,623.41 | $11,481.54 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,848.93 / $17,378.01 / $17,782.79
| Professional | | $15,848.93 | $17,378.01 | $17,782.79 |
- 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 / $33,884.42
| Professional | | $12,589.25 | $22,387.21 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $20,417.38 / $91,201.08
| Facility | | $11,481.54 | $20,417.38 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $11,220.18 / $18,620.87
| Professional | | $6,025.60 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,952.62 / $19,952.62 / $48,977.88
| Professional | | $19,952.62 | $19,952.62 | $48,977.88 |
- 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
- $25,118.86 / $45,708.82 / $48,977.88
| Professional | | $25,118.86 | $45,708.82 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $13,182.57 / $20,417.38
| Facility | | $7,943.28 | $13,182.57 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $9,120.11 / $14,125.38
| Professional | | $6,606.93 | $9,120.11 | $14,125.38 |