- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $14,125.38 / $33,884.42
| Facility | | $5,623.41 | $14,125.38 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $2,290.87 / $6,456.54
| Professional | | $562.34 | $2,290.87 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $251.19 / $691.83 / $1,202.26
| Professional | AS | $251.19 | $691.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $1,000.00 / $2,630.27
| Professional | | $173.78 | $1,000.00 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,882.50 / $16,982.44 / $33,113.11
| Facility | | $12,882.50 | $16,982.44 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,949.84 / $2,754.23
| Professional | | $1,174.90 | $1,949.84 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,884.03 / $3,890.45
| Professional | | $1,479.11 | $2,884.03 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $9,772.37 / $21,379.62
| Facility | | $1,513.56 | $9,772.37 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $2,290.87 / $35,481.34 / $35,481.34
| Facility | 54 | $2,290.87 | $35,481.34 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $2,041.74 / $31,622.78 / $31,622.78
| Facility | 62 | $2,041.74 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $323.59 / $5,128.61 / $5,128.61
| Facility | AS | $323.59 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,570.40 / $3,715.35
| Professional | | $1,584.89 | $2,570.40 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,090.30 / $3,981.07
| Professional | | $2,454.71 | $3,090.30 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,754.23 / $3,981.07
| Professional | | $2,454.71 | $2,754.23 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,137.96 / $2,818.38
| Professional | | $1,202.26 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $13,489.63 / $19,498.45
| Facility | | $8,317.64 | $13,489.63 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,398.83 / $3,715.35
| Professional | | $1,548.82 | $2,398.83 | $3,715.35 |