- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $7,943.28 / $22,908.68
| Facility | | $2,344.23 | $7,943.28 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,445.44 / $3,090.30
| Professional | | $1,122.02 | $1,445.44 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,398.83 / $3,162.28
| Professional | | $1,819.70 | $2,398.83 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $870.96 / $2,187.76
| Facility | | $501.19 | $870.96 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,949.84 / $3,801.89
| Professional | | $977.24 | $1,949.84 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,089.30 / $3,162.28
| Facility | | $1,202.26 | $2,089.30 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,995.26 / $3,162.28
| Professional | | $1,202.26 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $562.34
| Professional | | $32.36 | $33.11 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,454.71 / $2,511.89
| Facility | | $1,584.89 | $2,454.71 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,511.89 / $3,630.78
| Professional | | $1,737.80 | $2,511.89 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,454.71 / $3,162.28
| Professional | | $1,905.46 | $2,454.71 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,122.02 / $3,715.35
| Facility | | $691.83 | $1,122.02 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,778.28 / $3,311.31
| Professional | | $1,318.26 | $1,778.28 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,348.96 / $2,398.83
| Professional | | $1,174.90 | $1,348.96 | $2,398.83 |