- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $3,890.45 / $9,549.93
| Facility | | $831.76 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $4,073.80 / $5,370.32 / $5,370.32
| Facility | 22 | $4,073.80 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,995.26 / $3,801.89 / $19,054.61
| Facility | 50 | $1,995.26 | $3,801.89 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | AS | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $794.33 / $2,238.72
| Professional | | $524.81 | $794.33 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $5,248.07 / $11,481.54
| Facility | | $2,089.30 | $5,248.07 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $776.25 / $1,513.56
| Professional | | $489.78 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,584.89 / $4,365.16
| Facility | | $691.83 | $1,584.89 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | 22 | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | AS | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $851.14 / $1,949.84
| Professional | | $537.03 | $851.14 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,981.07 / $9,120.11
| Facility | | $1,513.56 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $724.44 / $1,737.80
| Professional | | $478.63 | $724.44 | $1,737.80 |