- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,890.45 / $14,454.40
| Facility | | $2,089.30 | $3,890.45 | $14,454.40 |
- 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
- $4,897.79 / $5,754.40 / $9,120.11
| Facility | | $4,897.79 | $5,754.40 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | 22 | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Facility | AS | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,511.89 / $9,549.93
| Facility | | $1,778.28 | $2,511.89 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,511.89 / $7,585.78
| Facility | | $1,737.80 | $2,511.89 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Facility | AS | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $3,890.45
| Facility | | $2,818.38 | $2,818.38 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,265.80 / $6,606.93
| Professional | | $2,344.23 | $4,265.80 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $17,782.79 / $17,782.79
| Facility | | $3,311.31 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | 22 | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $331.13 / $489.78 / $1,778.28
| Facility | AS | $331.13 | $489.78 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $6,918.31
| Professional | | $6,918.31 | $6,918.31 | $6,918.31 |
- 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 |