- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $3,715.35 / $12,882.50
| Facility | | $1,122.02 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,290.87 / $3,801.89
| Professional | | $1,949.84 | $2,290.87 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,715.35 / $12,302.69
| Facility | | $2,238.72 | $3,715.35 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $1,819.70 / $1,862.09
| Facility | | $79.43 | $1,819.70 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,884.03 / $4,677.35
| Professional | | $2,041.74 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $21,379.62
| Facility | | $54.95 | $56.23 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23,442.29 / $23,442.29 / $23,442.29
| Professional | | $23,442.29 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,019.95 / $5,623.41
| Facility | | $1,819.70 | $3,019.95 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,691.53 / $4,466.84
| Professional | | $1,995.26 | $2,691.53 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $275.42 / $1,819.70
| Professional | | $32.36 | $275.42 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $2,754.23
| Professional | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,884.03 / $5,011.87
| Facility | | $1,949.84 | $2,884.03 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,818.38 / $4,466.84
| Professional | | $1,995.26 | $2,818.38 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $6,165.95 / $11,481.54
| Facility | | $2,238.72 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,344.23 / $3,715.35
| Professional | | $1,778.28 | $2,344.23 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,819.70 / $1,905.46
| Professional | | $1,778.28 | $1,819.70 | $1,905.46 |