- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $6,456.54 / $15,488.17
| Facility | | $870.96 | $6,456.54 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | 22 | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $6,456.54 / $9,332.54 / $18,620.87
| Facility | 50 | $6,456.54 | $9,332.54 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $741.31 / $1,862.09
| Professional | | $389.05 | $741.31 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $977.24 / $1,230.27
| Professional | | $446.68 | $977.24 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $977.24 / $1,621.81
| Professional | | $398.11 | $977.24 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $954.99 / $14,454.40
| Facility | | $467.74 | $954.99 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $7,244.36 / $7,244.36 / $10,715.19
| Facility | 50 | $7,244.36 | $7,244.36 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | AS | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $794.33 / $3,981.07
| Professional | | $446.68 | $794.33 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $954.99 / $1,174.90
| Professional | | $724.44 | $954.99 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $831.76 / $1,174.90
| Professional | | $660.69 | $831.76 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $812.83 / $1,047.13
| Professional | | $436.52 | $812.83 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $11,220.18 / $15,848.93
| Facility | | $4,677.35 | $11,220.18 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $602.56 / $1,148.15
| Professional | | $416.87 | $602.56 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $851.14 / $1,000.00
| Professional | | $676.08 | $851.14 | $1,000.00 |