- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $3,715.35 / $10,715.19
| Facility | | $1,412.54 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,202.26 / $2,951.21
| Professional | | $1,023.29 | $1,202.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,019.95 / $5,888.44
| Facility | | $954.99 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,023.29 / $1,659.59
| Professional | | $831.76 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,174.90 / $1,737.80
| Facility | | $1,047.13 | $1,174.90 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,288.25
| Professional | | $1,148.15 | $1,148.15 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,698.24 / $2,290.87
| Facility | | $512.86 | $1,698.24 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,380.38 / $2,398.83
| Professional | | $562.34 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,698.24 / $2,818.38
| Facility | | $512.86 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,380.38 / $2,238.72
| Professional | | $407.38 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $3,388.44
| Facility | | $100.00 | $100.00 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,258.93 / $2,344.23
| Professional | | $1,071.52 | $1,258.93 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $5,248.07 / $8,709.64
| Facility | | $933.25 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,174.90 / $1,949.84
| Professional | | $851.14 | $1,174.90 | $1,949.84 |