- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,202.26 / $5,128.61
| Facility | | $177.83 | $1,202.26 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $630.96 / $2,454.71 / $7,762.47
| Facility | 50 | $630.96 | $2,454.71 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $239.88 / $676.08
| Professional | | $107.15 | $239.88 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $123.03 / $724.44 / $1,548.82
| Professional | 22 | $123.03 | $724.44 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $436.52 / $1,047.13
| Professional | 50 | $162.18 | $436.52 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $97.72 / $138.04
| Professional | 53 | $51.29 | $97.72 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,467.37 / $8,511.38
| Facility | | $2,454.71 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $154.88 / $257.04
| Professional | | $112.20 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $162.18 / $398.11
| Professional | 50 | $117.49 | $162.18 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $691.83 / $2,137.96
| Facility | | $186.21 | $691.83 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | 22 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | 53 | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $251.19 / $457.09
| Professional | | $123.03 | $251.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $275.42 / $1,380.38
| Professional | | $100.00 | $275.42 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $245.47 / $275.42
| Professional | | $100.00 | $245.47 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,290.87 / $3,890.45
| Facility | | $1,174.90 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $239.88 / $436.52
| Professional | | $123.03 | $239.88 | $436.52 |