- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $2,511.89 / $6,309.57
| Facility | | $457.09 | $2,511.89 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,548.82 / $2,511.89 / $2,511.89
| Facility | 22 | $1,548.82 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $446.68 / $1,445.44 / $4,168.69
| Facility | 52 | $446.68 | $1,445.44 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $89.13 / $169.82 / $346.74
| Facility | 53 | $89.13 | $169.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $363.08 / $977.24
| Professional | | $181.97 | $363.08 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $154.88 / $295.12
| Professional | 53 | $83.18 | $154.88 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,548.13 / $8,709.64
| Facility | | $1,380.38 | $3,548.13 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $323.59 / $602.56
| Professional | | $194.98 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $169.82 / $257.04
| Professional | 53 | $83.18 | $169.82 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $831.76 / $3,019.95
| Facility | | $309.03 | $831.76 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Facility | 22 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | 52 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | 53 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $758.58
| Professional | | $208.93 | $380.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $93.33 / $213.80 / $363.08
| Professional | 53 | $93.33 | $213.80 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,290.87 / $5,495.41
| Facility | | $691.83 | $2,290.87 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $346.74 / $691.83
| Professional | | $177.83 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $112.20 / $239.88 / $707.95
| Professional | 53 | $112.20 | $239.88 | $707.95 |