- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,715.35 / $14,791.08
| Facility | | $2,089.30 | $3,715.35 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $3,388.44 / $13,803.84
| Professional | | $467.74 | $3,388.44 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,128.61 / $26,302.68
| Facility | | $56.23 | $5,128.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $3,715.35 / $13,489.63
| Professional | | $436.52 | $3,715.35 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $1,096.48
| Facility | | $467.74 | $467.74 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $2,754.23 / $9,772.37
| Professional | | $616.60 | $2,754.23 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $3,162.28 / $12,882.50
| Professional | | $562.34 | $3,162.28 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $4,897.79
| Facility | | $407.38 | $537.03 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $6,456.54 / $9,332.54
| Professional | | $5,248.07 | $6,456.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $6,918.31 / $20,417.38
| Facility | | $3,467.37 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $4,466.84 / $11,481.54
| Professional | | $446.68 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $9,772.37 / $14,125.38
| Facility | | $4,168.69 | $9,772.37 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,128.61 / $26,302.68
| Facility | | $56.23 | $5,128.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $3,715.35 / $13,489.63
| Professional | | $436.52 | $3,715.35 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,918.31 / $30,199.52
| Facility | | $3,235.94 | $6,918.31 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $5,248.07 / $12,589.25
| Professional | | $524.81 | $5,248.07 | $12,589.25 |