- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $4,677.35 / $8,317.64
| Facility | | $1,380.38 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | 22 | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,148.15 / $2,951.21
| Professional | | $891.25 | $1,148.15 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $870.96 / $1,148.15
| Professional | | $123.03 | $870.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $18,197.01 / $28,840.32
| Facility | | $11,481.54 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,288.25 / $1,445.44
| Professional | | $1,023.29 | $1,288.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,380.38 / $1,737.80
| Professional | | $204.17 | $1,380.38 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,187.76 / $14,125.38
| Facility | | $1,122.02 | $2,187.76 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $269.15 / $1,905.46 / $1,905.46
| Facility | AS | $269.15 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,202.26 / $7,943.28
| Professional | | $933.25 | $1,202.26 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $7,079.46 / $14,454.40
| Facility | | $1,949.84 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,071.52 / $1,513.56
| Professional | | $851.14 | $1,071.52 | $1,513.56 |