- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,791.08 / $14,791.08 / $14,791.08
| Facility | | $14,791.08 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $12,882.50 / $15,135.61
| Professional | | $8,511.38 | $12,882.50 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,135.61 / $15,135.61 / $16,595.87
| Professional | | $15,135.61 | $15,135.61 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $13,803.84 / $13,803.84
| Facility | | $8,709.64 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,000.00 / $14,125.38
| Professional | | $10,000.00 | $10,000.00 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $11,481.54 / $14,125.38
| Professional | | $10,715.19 | $11,481.54 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $16,218.10 / $28,183.83
| Facility | | $8,128.31 | $16,218.10 | $28,183.83 |
- 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 / $14,454.40 / $16,218.10
| Facility | | $7,943.28 | $14,454.40 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $9,772.37 / $14,791.08
| Professional | | $7,943.28 | $9,772.37 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102,329.30 / $102,329.30 / $102,329.30
| Facility | | $102,329.30 | $102,329.30 | $102,329.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117,489.76 / $117,489.76 / $144,543.98
| Professional | | $117,489.76 | $117,489.76 | $144,543.98 |