- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $6,025.60 / $14,791.08
| Facility | | $1,479.11 | $6,025.60 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $4,365.16 / $7,079.46 / $16,982.44
| Facility | 22 | $4,365.16 | $7,079.46 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- 80
- Typical Low / Median / Typical High
- $19,952.62 / $19,952.62 / $19,952.62
| Facility | 80 | $19,952.62 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $316.23 / $10,964.78 / $11,220.18
| Facility | AS | $316.23 | $10,964.78 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,513.56 / $4,786.30
| Professional | | $933.25 | $1,513.56 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $12,589.25 / $23,988.33
| Facility | | $4,365.16 | $12,589.25 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,445.44 / $2,691.53
| Professional | | $977.24 | $1,445.44 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $4,168.69 / $15,135.61
| Facility | | $1,819.70 | $4,168.69 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | 22 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,584.89 / $3,311.31
| Professional | | $1,023.29 | $1,584.89 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $8,317.64 / $18,197.01
| Facility | | $3,162.28 | $8,317.64 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,348.96 / $3,162.28
| Professional | | $891.25 | $1,348.96 | $3,162.28 |