- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $8,128.31 / $28,183.83
| Facility | | $1,949.84 | $8,128.31 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $8,128.31 / $66,069.34 / $66,069.34
| Facility | 22 | $8,128.31 | $66,069.34 | $66,069.34 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $6,606.93
| Facility | AS | $5,623.41 | $5,623.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,862.09 / $4,786.30
| Professional | | $1,288.25 | $1,862.09 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $186.21 / $371.54 / $954.99
| Professional | AS | $186.21 | $371.54 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $14,125.38 / $28,840.32
| Facility | | $5,011.87 | $14,125.38 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,949.84 / $3,630.78
| Professional | | $1,348.96 | $1,949.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $186.21 / $257.04 / $489.78
| Professional | AS | $186.21 | $257.04 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,466.84 / $18,620.87
| Facility | | $1,737.80 | $4,466.84 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | 22 | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | AS | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,137.96 / $4,466.84
| Professional | | $1,412.54 | $2,137.96 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $12,882.50 / $33,884.42
| Facility | | $3,890.45 | $12,882.50 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,819.70 / $4,073.80
| Professional | | $1,202.26 | $1,819.70 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $524.81
| Professional | AS | $457.09 | $457.09 | $524.81 |