- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27,542.29 / $27,542.29 / $27,542.29
| Facility | | $27,542.29 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,589.25 / $27,542.29 / $190,546.07
| Professional | | $12,589.25 | $27,542.29 | $190,546.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38,018.94 / $41,686.94 / $42,657.95
| Professional | | $38,018.94 | $41,686.94 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30,199.52 / $30,199.52 / $48,977.88
| Facility | | $30,199.52 | $30,199.52 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30,199.52 / $54,954.09 / $75,857.76
| Professional | | $30,199.52 | $54,954.09 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27,542.29 / $47,863.01 / $204,173.79
| Facility | | $27,542.29 | $47,863.01 | $204,173.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14,454.40 / $26,302.68 / $43,651.58
| Professional | | $14,454.40 | $26,302.68 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47,863.01 / $47,863.01 / $117,489.76
| Professional | | $47,863.01 | $47,863.01 | $117,489.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48,977.88 / $48,977.88 / $48,977.88
| Facility | | $48,977.88 | $48,977.88 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60,255.96 / $109,647.82 / $117,489.76
| Professional | | $60,255.96 | $109,647.82 | $117,489.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25,703.96 / $30,199.52 / $45,708.82
| Facility | | $25,703.96 | $30,199.52 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,848.93 / $21,877.62 / $33,113.11
| Professional | | $15,848.93 | $21,877.62 | $33,113.11 |