- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,949.84 / $7,079.46
| Facility | | $478.63 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | 22 | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,174.90 / $1,230.27 / $1,380.38
| Facility | 52 | $1,174.90 | $1,230.27 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $467.74 / $1,096.48
| Professional | | $245.47 | $467.74 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $104.71 / $128.82 / $257.04
| Professional | 53 | $104.71 | $128.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $239.88 / $331.13
| Professional | | $199.53 | $239.88 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,019.95 / $6,165.95
| Facility | | $1,000.00 | $3,019.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $630.96
| Professional | | $257.04 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $346.74 / $436.52
| Professional | | $269.15 | $346.74 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $309.03 / $426.58
| Facility | | $245.47 | $309.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $524.81 / $977.24
| Professional | | $407.38 | $524.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $524.81 / $870.96
| Facility | | $426.58 | $524.81 | $870.96 |
- 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
- $263.03 / $467.74 / $870.96
| Professional | | $263.03 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | 53 | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,621.81 / $4,073.80
| Facility | | $758.58 | $1,621.81 | $4,073.80 |
- 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
- $245.47 / $416.87 / $758.58
| Professional | | $245.47 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | 53 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $281.84
| Professional | | $32.36 | $33.11 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $562.34 / $741.31
| Facility | | $100.00 | $562.34 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $489.78 / $741.31
| Professional | | $245.47 | $489.78 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,290.87 / $4,897.79
| Facility | | $724.44 | $2,290.87 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $724.44
| Professional | | $239.88 | $407.38 | $724.44 |