- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $3,715.35 / $9,120.11
| Facility | | $724.44 | $3,715.35 | $9,120.11 |
- 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
- $4,365.16 / $4,365.16 / $4,365.16
| Facility | 52 | $4,365.16 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $501.19 / $1,174.90
| Professional | | $251.19 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $93.33 / $141.25 / $467.74
| Professional | 53 | $93.33 | $141.25 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $245.47 / $416.87
| Professional | | $204.17 | $245.47 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $489.78
| Professional | 53 | $229.09 | $346.74 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,584.89 / $11,220.18
| Facility | | $489.78 | $1,584.89 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $416.87 / $549.54
| Professional | | $239.88 | $416.87 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $630.96 / $1,258.93
| Facility | | $426.58 | $630.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | 22 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | 52 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | 53 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $457.09 / $831.76
| Professional | | $269.15 | $457.09 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,365.16 / $8,912.51
| Facility | | $2,454.71 | $4,365.16 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $467.74 / $630.96
| Professional | | $257.04 | $467.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $190.55 / $562.34
| Professional | | $32.36 | $190.55 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,090.30 / $6,760.83
| Facility | | $707.95 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $741.31
| Professional | | $223.87 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $346.74 / $512.86
| Professional | | $190.55 | $346.74 | $512.86 |