- 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
- $2,818.38 / $3,467.37 / $5,495.41
| Professional | | $2,818.38 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,890.45 / $10,471.29
| Professional | | $3,090.30 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $3,019.95 / $3,090.30
| Facility | | $79.43 | $3,019.95 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,265.80 / $6,760.83
| Professional | | $2,951.21 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $26,302.68
| Facility | | $54.95 | $56.23 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24,547.09 / $28,840.32 / $28,840.32
| Professional | | $24,547.09 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,890.45 / $7,413.10
| Facility | | $2,187.76 | $3,890.45 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $4,265.80 / $6,760.83
| Professional | | $3,019.95 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $436.52 / $2,884.03
| Professional | | $32.36 | $436.52 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $3,981.07
| Professional | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,981.07 / $6,918.31
| Facility | | $3,019.95 | $3,981.07 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,365.16 / $6,760.83
| Professional | | $2,951.21 | $4,365.16 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $7,079.46 / $14,791.08
| Facility | | $2,754.23 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,467.37 / $5,370.32
| Professional | | $2,570.40 | $3,467.37 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,019.95 / $3,235.94
| Professional | | $2,951.21 | $3,019.95 | $3,235.94 |