- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $7,413.10 / $19,054.61
| Facility | | $3,090.30 | $7,413.10 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | 22 | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $9,772.37 / $10,471.29 / $21,379.62
| Facility | 50 | $9,772.37 | $10,471.29 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | AS | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,621.81 / $5,754.40
| Professional | | $794.33 | $1,621.81 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $165.96 / $346.74 / $977.24
| Professional | AS | $165.96 | $346.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $208.93 / $1,258.93
| Professional | | $154.88 | $208.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $14,454.40 / $28,183.83
| Facility | | $3,548.13 | $14,454.40 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,949.84 / $3,630.78
| Professional | | $1,513.56 | $1,949.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,659.59 / $2,691.53
| Professional | | $1,202.26 | $1,659.59 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $18,197.01
| Facility | | $1,230.27 | $1,905.46 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $34,673.69
| Facility | 54 | $2,290.87 | $2,290.87 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $5,011.87
| Facility | AS | $323.59 | $323.59 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,737.80 / $11,220.18
| Professional | | $1,230.27 | $1,737.80 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $11,481.54 / $18,620.87
| Facility | | $4,466.84 | $11,481.54 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,513.56 / $2,511.89
| Professional | | $1,174.90 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | AS | $302.00 | $302.00 | $302.00 |