- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $4,897.79 / $10,000.00
| Facility | | $1,122.02 | $4,897.79 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | 22 | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,659.59 / $4,466.84
| Professional | | $912.01 | $1,659.59 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $954.99 / $1,096.48
| Professional | | $138.04 | $954.99 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $6,165.95 / $14,125.38
| Facility | | $2,818.38 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,412.54 / $2,089.30
| Professional | | $1,071.52 | $1,412.54 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,174.90 / $1,621.81
| Professional | | $1,000.00 | $1,174.90 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $12,302.69 / $17,782.79
| Facility | | $6,165.95 | $12,302.69 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,412.54 / $2,290.87
| Professional | | $891.25 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,862.09 / $22,387.21
| Facility | | $1,000.00 | $1,862.09 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $269.15 / $1,905.46 / $1,905.46
| Facility | AS | $269.15 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,513.56 / $7,943.28
| Professional | | $1,023.29 | $1,513.56 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,677.35 / $10,232.93
| Facility | | $2,884.03 | $4,677.35 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,258.93 / $1,995.26
| Professional | | $954.99 | $1,258.93 | $1,995.26 |