- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $5,888.44 / $16,982.44
| Facility | | $3,162.28 | $5,888.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,819.70 / $3,630.78
| Professional | | $1,288.25 | $1,819.70 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $181.97 / $346.74 / $812.83
| Professional | AS | $181.97 | $346.74 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,905.46 / $2,630.27
| Professional | | $331.13 | $1,905.46 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | AS | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $6,309.57 / $28,183.83
| Facility | | $2,238.72 | $6,309.57 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,290.87 / $3,235.94
| Professional | | $1,479.11 | $2,290.87 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $213.80 / $323.59 / $457.09
| Professional | AS | $213.80 | $323.59 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,995.26 / $2,818.38
| Facility | | $1,698.24 | $1,995.26 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,737.80 / $1,995.26
| Professional | | $1,348.96 | $1,737.80 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22,387.21 / $22,387.21 / $22,387.21
| Facility | | $22,387.21 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,344.23 / $3,715.35
| Professional | | $1,548.82 | $2,344.23 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,862.09 / $4,570.88
| Professional | | $1,412.54 | $1,862.09 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | 22 | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | 80 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Professional | AS | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,511.89 / $2,570.40
| Professional | | $2,238.72 | $2,511.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $9,120.11 / $28,183.83
| Facility | | $2,884.03 | $9,120.11 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,949.84 / $3,235.94
| Professional | | $1,258.93 | $1,949.84 | $3,235.94 |