- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,890.45 / $10,964.78
| Facility | | $2,290.87 | $3,890.45 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,511.89 / $6,918.31
| Professional | | $1,949.84 | $2,511.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,187.76 / $5,370.32
| Professional | | $1,737.80 | $2,187.76 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $37,153.52
| Facility | | $3,019.95 | $3,019.95 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $3,019.95
| Professional | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $5,754.40 / $53,703.18
| Facility | | $34.67 | $5,754.40 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,801.89 / $9,549.93
| Professional | | $1,380.38 | $3,801.89 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,187.76 / $4,897.79
| Facility | | $1,122.02 | $2,187.76 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,691.53 / $3,890.45
| Professional | | $1,949.84 | $2,691.53 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,818.38 / $4,466.84
| Professional | | $1,698.24 | $2,818.38 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $50,118.72 / $75,857.76
| Facility | | $2,089.30 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,754.23 / $4,570.88
| Professional | | $398.11 | $2,754.23 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $4,073.80 / $9,332.54
| Facility | | $1,479.11 | $4,073.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,818.38 / $6,760.83
| Professional | | $1,584.89 | $2,818.38 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,238.72 / $5,623.41
| Facility | | $1,698.24 | $2,238.72 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,570.40 / $5,623.41
| Professional | | $1,698.24 | $2,570.40 | $5,623.41 |