- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $7,943.28 / $11,748.98
| Facility | | $954.99 | $7,943.28 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | 22 | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $977.24 / $2,754.23
| Professional | | $630.96 | $977.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $741.31 / $851.14
| Professional | | $537.03 | $741.31 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $8,912.51 / $18,197.01
| Facility | | $4,677.35 | $8,912.51 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $707.95 / $954.99
| Professional | | $588.84 | $707.95 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $794.33 / $1,047.13
| Facility | | $616.60 | $794.33 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $758.58 / $1,000.00
| Professional | | $616.60 | $758.58 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $1,122.02 / $1,122.02
| Facility | | $34.67 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 22 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $912.01
| Facility | 52 | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | 53 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | AS | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $954.99 / $3,981.07
| Professional | | $645.65 | $954.99 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $660.69
| Professional | | $32.36 | $33.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $5,011.87 / $12,302.69
| Facility | | $851.14 | $5,011.87 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $831.76 / $1,288.25
| Professional | | $588.84 | $831.76 | $1,288.25 |