- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,398.83 / $14,454.40
| Facility | | $1,288.25 | $2,398.83 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $12,882.50 / $22,908.68
| Facility | | $9,120.11 | $12,882.50 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,548.13 / $5,623.41
| Facility | | $3,019.95 | $3,548.13 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | 22 | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Facility | AS | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,659.59 / $9,549.93
| Facility | | $1,174.90 | $1,659.59 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,698.24 / $7,585.78
| Facility | | $1,174.90 | $1,698.24 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | AS | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $2,454.71
| Facility | | $1,737.80 | $1,737.80 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,691.53 / $4,168.69
| Professional | | $1,479.11 | $2,691.53 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,019.95 / $10,964.78
| Facility | | $2,041.74 | $3,019.95 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | 22 | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $1,096.48
| Facility | AS | $204.17 | $302.00 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $6,760.83 / $19,498.45
| Facility | | $1,995.26 | $6,760.83 | $19,498.45 |