- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30,902.95 / $30,902.95 / $30,902.95
| Facility | | $30,902.95 | $30,902.95 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,803.84 / $30,902.95 / $204,173.79
| Professional | | $13,803.84 | $30,902.95 | $204,173.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42,657.95 / $46,773.51 / $46,773.51
| Professional | | $42,657.95 | $46,773.51 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31,622.78 / $31,622.78 / $53,703.18
| Facility | | $31,622.78 | $31,622.78 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31,622.78 / $56,234.13 / $83,176.38
| Professional | | $31,622.78 | $56,234.13 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30,902.95 / $52,480.75 / $223,872.11
| Facility | | $30,902.95 | $52,480.75 | $223,872.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,848.93 / $28,183.83 / $47,863.01
| Professional | | $15,848.93 | $28,183.83 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52,480.75 / $52,480.75 / $128,824.96
| Professional | | $52,480.75 | $52,480.75 | $128,824.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53,703.18 / $53,703.18 / $53,703.18
| Facility | | $53,703.18 | $53,703.18 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66,069.34 / $120,226.44 / $128,824.96
| Professional | | $66,069.34 | $120,226.44 | $128,824.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28,183.83 / $33,113.11 / $50,118.72
| Facility | | $28,183.83 | $33,113.11 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17,378.01 / $23,988.33 / $36,307.81
| Professional | | $17,378.01 | $23,988.33 | $36,307.81 |