- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $4,073.80 / $12,882.50
| Facility | | $1,148.15 | $4,073.80 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,951.21 / $22,387.21 / $22,387.21
| Facility | 50 | $2,951.21 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $8,912.51 / $18,197.01
| Facility | | $5,128.61 | $8,912.51 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $7,943.28 / $7,943.28
| Facility | | $1,174.90 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,630.78 / $6,918.31
| Facility | | $2,187.76 | $3,630.78 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | 22 | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | AS | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $18,197.01 / $20,892.96
| Facility | | $5,011.87 | $18,197.01 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | AS | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,862.09 / $6,456.54
| Facility | | $1,174.90 | $1,862.09 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $22,387.21
| Facility | 50 | $2,951.21 | $2,951.21 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,659.59 / $3,019.95
| Facility | | $1,202.26 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | 22 | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | AS | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $7,413.10 / $14,454.40
| Facility | | $2,754.23 | $7,413.10 | $14,454.40 |