- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $5,495.41 / $8,912.51
| Facility | | $1,023.29 | $5,495.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,096.48 / $5,370.32
| Professional | | $407.38 | $1,096.48 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $7,413.10 / $17,782.79
| Facility | | $2,238.72 | $7,413.10 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,019.95 / $4,265.80
| Professional | | $707.95 | $3,019.95 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $776.25 / $3,715.35
| Professional | | $446.68 | $776.25 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,071.52 / $6,309.57
| Facility | | $426.58 | $1,071.52 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,202.26 / $4,786.30
| Professional | | $616.60 | $1,202.26 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $15,488.17 / $22,908.68
| Facility | | $12,302.69 | $15,488.17 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,511.89 / $4,786.30
| Professional | | $707.95 | $2,511.89 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,187.76 / $10,232.93
| Professional | | $758.58 | $2,187.76 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $12,882.50 / $165,958.69
| Facility | | $2,570.40 | $12,882.50 | $165,958.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,174.90 / $2,884.03
| Professional | | $457.09 | $1,174.90 | $2,884.03 |