- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,862.09 / $4,570.88
| Facility | | $263.03 | $1,862.09 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $630.96 / $2,398.83 / $5,495.41
| Facility | 50 | $630.96 | $2,398.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $70.79 / $158.49
| Professional | | $44.67 | $70.79 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $281.84 / $630.96 / $954.99
| Professional | 22 | $281.84 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $257.04
| Professional | 50 | $69.18 | $114.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $125.89
| Professional | | $47.86 | $75.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $114.82 / $186.21
| Professional | 50 | $83.18 | $114.82 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,089.30 / $3,981.07
| Facility | | $741.31 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $89.13 / $141.25
| Professional | | $58.88 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $208.93
| Professional | 50 | $89.13 | $134.90 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $89.13
| Facility | | $53.70 | $63.10 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $89.13
| Professional | | $58.88 | $75.86 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $144.54
| Professional | | $54.95 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $77.62 / $123.03
| Professional | | $44.67 | $77.62 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $190.55
| Professional | 22 | $131.83 | $131.83 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $54.95
| Professional | 52 | $38.90 | $38.90 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,023.29 / $1,778.28
| Facility | | $691.83 | $1,023.29 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $131.83
| Professional | | $64.57 | $79.43 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,318.26 / $2,344.23
| Facility | | $213.80 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $74.13 / $131.83
| Professional | | $45.71 | $74.13 | $131.83 |