- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $3,801.89 / $12,882.50
| Facility | | $1,122.02 | $3,801.89 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,715.35 / $4,073.80
| Professional | | $2,511.89 | $3,715.35 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $19,952.62 / $40,738.03
| Facility | | $11,748.98 | $19,952.62 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $12,302.69 / $13,489.63
| Facility | | $537.03 | $12,302.69 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17,378.01 / $17,378.01 / $17,378.01
| Professional | | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52,480.75 / $52,480.75 / $52,480.75
| Facility | | $52,480.75 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28,183.83 / $33,113.11 / $33,113.11
| Professional | | $28,183.83 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,981.07 / $7,762.47
| Facility | | $1,584.89 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,715.35 / $4,073.80
| Professional | | $2,344.23 | $3,715.35 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,073.80 / $7,413.10
| Facility | | $2,454.71 | $4,073.80 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $3,801.89 / $19,054.61
| Professional | | $1,258.93 | $3,801.89 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,589.25 / $15,488.17 / $28,183.83
| Facility | | $12,589.25 | $15,488.17 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,365.16 / $5,754.40
| Professional | | $3,388.44 | $4,365.16 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,235.94 / $4,073.80
| Professional | | $776.25 | $3,235.94 | $4,073.80 |