- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $4,365.16 / $10,964.78
| Facility | | $1,122.02 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $812.83 / $2,511.89
| Professional | | $645.65 | $812.83 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,495.41 / $12,882.50
| Facility | | $3,388.44 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $812.83 / $1,778.28
| Professional | | $616.60 | $812.83 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,398.83 / $10,964.78
| Facility | | $1,122.02 | $2,398.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $4,786.30 / $53,703.18
| Facility | | $1,348.96 | $4,786.30 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,071.52 / $2,754.23
| Professional | | $549.54 | $1,071.52 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $912.01 / $2,511.89
| Facility | | $616.60 | $912.01 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $1,819.70
| Professional | | $758.58 | $1,023.29 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $851.14 / $1,479.11
| Professional | | $588.84 | $851.14 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $50,118.72 / $75,857.76
| Facility | | $758.58 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $933.25 / $1,230.27
| Professional | | $398.11 | $933.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $4,897.79 / $10,232.93
| Facility | | $2,398.83 | $4,897.79 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $954.99 / $2,398.83
| Professional | | $489.78 | $954.99 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $851.14 / $2,511.89
| Facility | | $575.44 | $851.14 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $933.25 / $2,511.89
| Professional | | $588.84 | $933.25 | $2,511.89 |