- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,090.30 / $20,892.96
| Facility | | $2,187.76 | $3,090.30 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,412.54 / $3,548.13
| Professional | | $1,023.29 | $1,412.54 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,290.87 / $3,162.28
| Professional | | $1,548.82 | $2,290.87 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,995.26 / $2,290.87
| Facility | | $707.95 | $1,995.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,949.84 / $3,467.37
| Professional | | $1,096.48 | $1,949.84 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,778.28 / $2,884.03
| Facility | | $1,071.52 | $1,778.28 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,819.70 / $2,951.21
| Professional | | $1,071.52 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $79.43
| Professional | | $32.36 | $33.11 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,238.72 / $2,344.23
| Facility | | $1,348.96 | $2,238.72 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $1,737.80
| Facility | | $1,513.56 | $1,513.56 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,398.83 / $3,162.28
| Professional | | $1,737.80 | $2,398.83 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,344.23 / $3,090.30
| Professional | | $1,548.82 | $2,344.23 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,244.36 / $13,182.57
| Facility | | $6,025.60 | $7,244.36 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,659.59 / $3,019.95
| Professional | | $1,230.27 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,412.54 / $2,511.89
| Professional | | $1,318.26 | $1,412.54 | $2,511.89 |