- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $5,754.40 / $13,803.84
| Facility | | $1,174.90 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $28,183.83 / $28,183.83 / $28,183.83
| Facility | 22 | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $5,011.87
| Facility | 52 | $1,023.29 | $1,023.29 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $933.25 / $2,454.71
| Professional | | $707.95 | $933.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $7,762.47 / $16,595.87
| Facility | | $2,951.21 | $7,762.47 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,047.13 / $1,995.26
| Professional | | $691.83 | $1,047.13 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,511.89 / $11,481.54
| Facility | | $1,174.90 | $2,511.89 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | 22 | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 52 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,148.15 / $2,344.23
| Professional | | $707.95 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $6,760.83 / $15,488.17
| Facility | | $2,570.40 | $6,760.83 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,000.00 / $1,778.28
| Professional | | $645.65 | $1,000.00 | $1,778.28 |