- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,162.28 / $14,454.40
| Facility | | $1,698.24 | $3,162.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,317.64 / $13,803.84
| Facility | | $5,011.87 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $4,570.88 / $7,413.10
| Facility | | $3,981.07 | $4,570.88 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | 22 | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | AS | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,995.26 / $4,073.80
| Facility | | $1,258.93 | $1,995.26 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,995.26 / $6,309.57
| Facility | | $1,258.93 | $1,995.26 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | AS | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $3,090.30
| Facility | | $2,238.72 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $3,467.37 / $5,370.32
| Professional | | $1,949.84 | $3,467.37 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $12,589.25 / $12,589.25
| Facility | | $2,691.53 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | 22 | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $269.15 / $398.11 / $1,258.93
| Facility | AS | $269.15 | $398.11 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Professional | | $5,623.41 | $5,623.41 | $5,623.41 |
- 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 |