- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,548.13 / $10,964.78
| Facility | | $1,819.70 | $3,548.13 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,659.59 / $3,388.44
| Professional | | $1,380.38 | $1,659.59 | $3,388.44 |
- 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
- $1,258.93 / $1,479.11 / $2,951.21
| Professional | | $1,258.93 | $1,479.11 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $37,153.52
| Facility | | $2,187.76 | $2,187.76 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,187.76
| Professional | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $2,630.27 / $50,118.72
| Facility | | $34.67 | $2,630.27 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,137.96 / $5,623.41
| Professional | | $1,071.52 | $2,137.96 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,778.28 / $4,265.80
| Facility | | $1,047.13 | $1,778.28 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,238.72 / $3,467.37
| Professional | | $1,698.24 | $2,238.72 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,949.84 / $3,235.94
| Professional | | $1,122.02 | $1,949.84 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $50,118.72 / $75,857.76
| Facility | | $1,412.54 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,041.74 / $3,388.44
| Professional | | $398.11 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,981.07 / $8,912.51
| Facility | | $1,445.44 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,454.71 / $8,511.38
| Professional | | $1,479.11 | $2,454.71 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,819.70 / $5,248.07
| Facility | | $1,230.27 | $1,819.70 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,819.70 / $3,890.45
| Professional | | $1,230.27 | $1,819.70 | $3,890.45 |