- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $4,168.69 / $7,413.10
| Facility | | $977.24 | $4,168.69 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | 22 | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | 52 | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $436.52 / $1,047.13
| Professional | | $194.98 | $436.52 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $162.18 / $275.42 / $977.24
| Professional | 52 | $162.18 | $275.42 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $169.82 / $234.42
| Professional | 53 | $91.20 | $169.82 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,168.69 / $10,964.78
| Facility | | $2,818.38 | $4,168.69 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $537.03 / $851.14
| Professional | | $239.88 | $537.03 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,230.27 / $1,778.28
| Facility | | $1,023.29 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $501.19 / $1,047.13
| Professional | | $245.47 | $501.19 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $977.24 / $1,023.29
| Facility | | $758.58 | $977.24 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $691.83 / $1,023.29
| Professional | | $371.54 | $691.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,754.23 / $3,162.28
| Facility | | $2,089.30 | $2,754.23 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $407.38 / $776.25
| Professional | | $181.97 | $407.38 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $4,677.35 / $8,912.51
| Facility | | $1,348.96 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $467.74 / $1,023.29
| Professional | | $199.53 | $467.74 | $1,023.29 |