- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,137.96 / $6,309.57
| Facility | | $776.25 | $2,137.96 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,621.81 / $2,691.53 / $5,495.41
| Facility | 50 | $1,621.81 | $2,691.53 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $229.09 / $645.65
| Professional | | $104.71 | $229.09 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $1,548.82
| Professional | 22 | $141.25 | $190.55 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $371.54 / $1,122.02
| Professional | 50 | $162.18 | $371.54 | $1,122.02 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $213.80 / $338.84
| Professional | | $104.71 | $213.80 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $331.13 / $549.54
| Professional | 50 | $151.36 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Professional | 53 | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $912.01 / $7,413.10
| Facility | | $281.84 | $912.01 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $218.78 / $269.15
| Professional | | $104.71 | $218.78 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $478.63 / $501.19
| Facility | | $186.21 | $478.63 | $501.19 |
- 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
- $104.71 / $208.93 / $426.58
| Professional | | $104.71 | $208.93 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | 53 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,388.44 / $7,585.78
| Facility | | $2,290.87 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $204.17 / $281.84
| Professional | | $141.25 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $85.11 / $331.13
| Professional | | $32.36 | $85.11 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,290.87 / $5,011.87
| Facility | | $588.84 | $2,290.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $186.21 / $380.19
| Professional | | $89.13 | $186.21 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $186.21 / $269.15
| Professional | | $85.11 | $186.21 | $269.15 |