- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $8,912.51 / $16,982.44
| Facility | | $4,265.80 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $4,786.30 / $10,471.29 / $10,471.29
| Facility | 22 | $4,786.30 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 80
- Typical Low / Median / Typical High
- $24,547.09 / $24,547.09 / $24,547.09
| Facility | 80 | $24,547.09 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $977.24 / $2,089.30
| Professional | | $630.96 | $977.24 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $831.76 / $1,230.27
| Professional | | $602.56 | $831.76 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $5,128.61 / $15,135.61
| Facility | | $1,513.56 | $5,128.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,202.26 / $2,089.30
| Professional | | $741.31 | $1,202.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $912.01 / $1,202.26
| Facility | | $758.58 | $912.01 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $794.33 / $1,023.29
| Professional | | $616.60 | $794.33 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $3,630.78 / $9,332.54
| Facility | | $1,288.25 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $954.99 / $1,548.82
| Professional | | $630.96 | $954.99 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $851.14 / $1,737.80
| Professional | | $660.69 | $851.14 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $2,344.23
| Professional | 22 | $1,862.09 | $1,862.09 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $691.83
| Professional | 52 | $537.03 | $537.03 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $537.03 / $691.83 / $891.25
| Professional | 53 | $537.03 | $691.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $63.10
| Professional | 80 | $48.98 | $48.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $31.62
| Professional | AS | $24.55 | $24.55 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,202.26 / $1,584.89
| Professional | | $660.69 | $1,202.26 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $6,309.57 / $14,791.08
| Facility | | $870.96 | $6,309.57 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $831.76 / $1,445.44
| Professional | | $616.60 | $831.76 | $1,445.44 |