- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $32,359.37 / $32,359.37
| Facility | | $1,862.09 | $32,359.37 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $12,882.50 / $20,417.38
| Facility | | $9,120.11 | $12,882.50 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,011.87 / $7,943.28
| Facility | | $4,265.80 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 22 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,290.87 / $9,332.54
| Facility | | $1,548.82 | $2,290.87 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,238.72 / $7,585.78
| Facility | | $1,513.56 | $2,238.72 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | AS | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $3,467.37
| Facility | | $2,454.71 | $2,454.71 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,801.89 / $5,888.44
| Professional | | $2,089.30 | $3,801.89 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $15,488.17 / $15,488.17
| Facility | | $2,951.21 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 22 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $295.12 / $426.58 / $1,548.82
| Facility | AS | $295.12 | $426.58 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,165.95 / $6,165.95
| Professional | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $6,918.31 / $19,498.45
| Facility | | $2,290.87 | $6,918.31 | $19,498.45 |