- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,019.95 / $8,511.38
| Facility | | $758.58 | $3,019.95 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | 22 | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | 52 | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $295.12 / $870.96
| Professional | | $72.44 | $295.12 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $134.90 / $257.04
| Professional | | $72.44 | $134.90 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,584.89 / $11,220.18
| Facility | | $446.68 | $1,584.89 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $323.59 / $426.58
| Professional | | $131.83 | $323.59 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $501.19 / $1,023.29
| Facility | | $234.42 | $501.19 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | 22 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | 52 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Facility | 53 | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $316.23 / $630.96
| Professional | | $147.91 | $316.23 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,388.44 / $7,585.78
| Facility | | $2,238.72 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $309.03 / $478.63
| Professional | | $165.96 | $309.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $104.71 / $467.74
| Professional | | $32.36 | $104.71 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,090.30 / $6,918.31
| Facility | | $707.95 | $3,090.30 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $288.40 / $549.54
| Professional | | $123.03 | $288.40 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $281.84 / $426.58
| Professional | | $104.71 | $281.84 | $426.58 |