- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $5,495.41 / $10,000.00
| Facility | | $912.01 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $3,548.13 / $12,589.25 / $12,589.25
| Facility | 22 | $3,548.13 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,122.02 / $2,630.27 / $6,606.93
| Facility | 52 | $1,122.02 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $2,187.76 / $3,890.45 / $6,606.93
| Facility | 53 | $2,187.76 | $3,890.45 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $501.19 / $2,089.30
| Professional | | $229.09 | $501.19 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $77.62 / $138.04 / $1,584.89
| Professional | 53 | $77.62 | $138.04 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $5,495.41 / $12,882.50
| Facility | | $2,041.74 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $588.84 / $2,290.87
| Professional | | $269.15 | $588.84 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $4,897.79 / $19,054.61
| Facility | | $398.11 | $4,897.79 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | 22 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Facility | 52 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | 53 | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $549.54 / $3,019.95
| Professional | | $263.03 | $549.54 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $891.25 / $954.99 / $3,019.95
| Professional | 53 | $891.25 | $954.99 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,168.69 / $9,772.37
| Facility | | $1,737.80 | $4,168.69 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $2,398.83
| Professional | | $245.47 | $457.09 | $2,398.83 |