- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $3,090.30 / $6,456.54
| Facility | | $1,318.26 | $3,090.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 22 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | 52 | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $436.52 / $1,148.15
| Professional | | $194.98 | $436.52 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $162.18 / $208.93 / $812.83
| Professional | 52 | $162.18 | $208.93 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $97.72 / $199.53 / $398.11
| Professional | 53 | $97.72 | $199.53 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $389.05 / $794.33
| Professional | | $223.87 | $389.05 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $616.60
| Professional | | $32.36 | $33.11 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,290.87 / $3,548.13
| Facility | | $1,698.24 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $537.03 / $870.96
| Professional | | $269.15 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $489.78 / $1,023.29
| Professional | | $223.87 | $489.78 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $549.54 / $870.96
| Professional | | $257.04 | $549.54 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $4,466.84 / $5,128.61
| Facility | | $870.96 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $389.05 / $691.83
| Professional | | $194.98 | $389.05 | $691.83 |