- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,995.26 / $4,365.16
| Facility | | $309.03 | $1,995.26 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | 22 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $95.50 / $177.83 / $275.42
| Facility | 53 | $95.50 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $354.81 / $1,071.52
| Professional | | $173.78 | $354.81 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $154.88 / $288.40
| Professional | 53 | $83.18 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $169.82 / $338.84
| Professional | | $151.36 | $169.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $83.18 / $107.15
| Professional | 53 | $74.13 | $83.18 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,548.82 / $3,235.94
| Facility | | $758.58 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $309.03 / $446.68
| Professional | | $204.17 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $169.82
| Professional | 53 | $79.43 | $125.89 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $371.54 / $537.03
| Professional | | $177.83 | $371.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $89.13 / $177.83 / $269.15
| Professional | 53 | $89.13 | $177.83 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,677.35
| Facility | | $1,698.24 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $616.60
| Professional | | $204.17 | $346.74 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $144.54 / $269.15 / $338.84
| Professional | 53 | $144.54 | $269.15 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $389.05 / $1,698.24
| Facility | | $190.55 | $389.05 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | 52 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | 53 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $549.54 / $2,754.23
| Professional | | $269.15 | $549.54 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Professional | 53 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,148.15 / $2,691.53
| Facility | | $741.31 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $331.13 / $602.56
| Professional | | $181.97 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $154.88 / $251.19 / $1,318.26
| Professional | 53 | $154.88 | $251.19 | $1,318.26 |