- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $5,248.07 / $11,220.18
| Facility | | $1,000.00 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $676.08 / $11,220.18 / $11,220.18
| Facility | 22 | $676.08 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,754.23 / $6,760.83 / $17,378.01
| Facility | 50 | $2,754.23 | $6,760.83 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Facility | AS | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $2,398.83
| Professional | | $537.03 | $776.25 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $7,413.10 / $16,218.10
| Facility | | $2,398.83 | $7,413.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $741.31 / $1,445.44
| Professional | | $398.11 | $741.31 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,187.76 / $11,220.18
| Facility | | $1,122.02 | $2,187.76 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 22 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | AS | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $954.99 / $1,995.26
| Professional | | $489.78 | $954.99 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,265.80 / $10,471.29
| Facility | | $1,737.80 | $4,265.80 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $794.33 / $1,548.82
| Professional | | $489.78 | $794.33 | $1,548.82 |