- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $16,595.87 / $26,915.35
| Facility | | $4,786.30 | $16,595.87 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $16,218.10 / $16,218.10 / $16,218.10
| Facility | 22 | $16,218.10 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $9,549.93 / $13,182.57 / $14,791.08
| Facility | 50 | $9,549.93 | $13,182.57 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,698.24 / $3,548.13
| Professional | | $616.60 | $1,698.24 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $165.96 / $331.13 / $489.78
| Professional | AS | $165.96 | $331.13 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,862.09 / $2,884.03
| Professional | | $1,174.90 | $1,862.09 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $162.18 / $263.03 / $398.11
| Professional | AS | $162.18 | $263.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,905.46 / $2,884.03
| Professional | | $1,445.44 | $1,905.46 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,778.28 / $3,235.94
| Professional | | $1,445.44 | $1,778.28 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,698.24
| Facility | | $1,412.54 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,698.24 / $2,691.53
| Professional | | $1,288.25 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,698.24 / $2,691.53
| Professional | | $1,258.93 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | AS | $85.11 | $85.11 | $85.11 |