- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $4,570.88 / $12,302.69
| Facility | | $354.81 | $4,570.88 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- 80
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | 80 | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $407.38 / $1,819.70
| Professional | | $190.55 | $407.38 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,760.83 / $14,125.38
| Facility | | $3,548.13 | $6,760.83 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $331.13 / $575.44
| Professional | | $204.17 | $331.13 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $776.25 / $15,488.17
| Facility | | $354.81 | $776.25 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | 22 | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | 62 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Facility | AS | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $707.95
| Professional | | $208.93 | $323.59 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,258.93 / $5,248.07
| Facility | | $295.12 | $1,258.93 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $676.08
| Professional | | $177.83 | $269.15 | $676.08 |