- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,570.88 / $20,892.96
| Facility | | $3,311.31 | $4,570.88 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,995.26 / $4,365.16
| Professional | | $1,584.89 | $1,995.26 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,388.44 / $4,466.84
| Professional | | $2,570.40 | $3,388.44 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $870.96 / $3,019.95
| Facility | | $501.19 | $870.96 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,754.23 / $5,248.07
| Professional | | $1,380.38 | $2,754.23 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,951.21 / $4,466.84
| Facility | | $1,698.24 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,818.38 / $4,466.84
| Professional | | $1,659.59 | $2,818.38 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $776.25
| Professional | | $32.36 | $33.11 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,388.44 / $3,548.13
| Facility | | $2,238.72 | $3,388.44 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,454.71
| Facility | | $2,398.83 | $2,398.83 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,548.13 / $5,128.61
| Professional | | $2,454.71 | $3,548.13 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,467.37 / $4,365.16
| Professional | | $2,691.53 | $3,467.37 | $4,365.16 |
- 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
- $1,778.28 / $2,511.89 / $4,570.88
| Professional | | $1,778.28 | $2,511.89 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,862.09 / $3,311.31
| Professional | | $1,621.81 | $1,862.09 | $3,311.31 |