- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,089.30 / $6,025.60
| Facility | | $588.84 | $2,089.30 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 22 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $588.84 / $2,187.76
| Professional | | $245.47 | $588.84 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $23.99 / $70.79 / $177.83
| Professional | AS | $23.99 | $70.79 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,548.82 / $5,011.87
| Facility | | $501.19 | $1,548.82 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Facility | 62 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $389.05 / $1,148.15
| Professional | | $229.09 | $389.05 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $478.63 / $660.69
| Professional | | $288.40 | $478.63 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $234.42
| Professional | AS | $44.67 | $67.61 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $741.31
| Professional | | $245.47 | $389.05 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $3,311.31
| Facility | | $204.17 | $302.00 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $302.00 / $426.58
| Professional | | $245.47 | $302.00 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $436.52 / $630.96
| Professional | | $234.42 | $436.52 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,949.84 / $5,370.32
| Facility | | $741.31 | $1,949.84 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $380.19 / $562.34
| Professional | | $47.86 | $380.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,548.82 / $5,011.87
| Facility | | $501.19 | $1,548.82 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Facility | 62 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $389.05 / $1,148.15
| Professional | | $229.09 | $389.05 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,862.09 / $2,818.38
| Facility | | $524.81 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $416.87 / $724.44
| Professional | | $269.15 | $416.87 | $724.44 |