- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,698.24 / $14,454.40
| Facility | | $912.01 | $1,698.24 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,128.31 / $13,803.84
| Facility | | $5,011.87 | $8,128.31 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,511.89 / $3,981.07
| Facility | | $2,137.96 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | 22 | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,148.15 / $8,912.51
| Facility | | $831.76 | $1,148.15 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,174.90 / $6,309.57
| Facility | | $831.76 | $1,174.90 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | AS | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,698.24
| Facility | | $1,230.27 | $1,230.27 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,905.46 / $2,951.21
| Professional | | $1,047.13 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $7,762.47 / $7,762.47
| Facility | | $1,479.11 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | 22 | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $776.25
| Facility | AS | $147.91 | $213.80 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | | $3,090.30 | $3,090.30 | $3,090.30 |
- 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 |