- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $15,848.93
| Facility | | $2,041.74 | $2,041.74 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,041.74 / $14,125.38
| Professional | | $1,621.81 | $2,041.74 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,949.84 / $8,317.64
| Facility | | $1,548.82 | $1,949.84 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $5,495.41
| Professional | | $2,041.74 | $2,041.74 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $5,370.32 / $8,709.64
| Facility | | $2,187.76 | $5,370.32 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,760.83 / $13,803.84
| Professional | | $3,548.13 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,691.53 / $2,691.53
| Facility | | $1,737.80 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $2,691.53
| Professional | | $1,949.84 | $1,949.84 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,737.80 / $4,466.84
| Professional | | $1,412.54 | $1,737.80 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,388.44 / $5,754.40
| Professional | | $2,238.72 | $3,388.44 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $28,183.83 / $28,183.83
| Professional | | $19,498.45 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $3,801.89
| Professional | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,388.44 / $4,677.35
| Facility | | $1,380.38 | $3,388.44 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $3,715.35
| Professional | | $1,949.84 | $1,949.84 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $6,918.31
| Professional | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,819.70 / $3,388.44
| Professional | | $1,412.54 | $1,819.70 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $2,238.72 / $4,570.88
| Facility | | $281.84 | $2,238.72 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,041.74 / $3,981.07
| Professional | | $1,584.89 | $2,041.74 | $3,981.07 |