- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $3,019.95 / $7,079.46
| Facility | | $295.12 | $3,019.95 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $3,162.28 / $6,456.54
| Facility | 50 | $645.65 | $3,162.28 | $6,456.54 |
- 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
- $478.63 / $812.83 / $1,548.82
| Professional | 22 | $478.63 | $812.83 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $436.52 / $1,023.29
| Professional | 50 | $158.49 | $436.52 | $1,023.29 |
- 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
- $107.15 / $190.55 / $501.19
| Professional | | $107.15 | $190.55 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $323.59 / $776.25
| Professional | 50 | $158.49 | $323.59 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,819.70 / $3,981.07
| Facility | | $758.58 | $1,819.70 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $186.21 / $354.81
| Professional | | $123.03 | $186.21 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $537.03
| Professional | 50 | $190.55 | $281.84 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $151.36 / $213.80
| Facility | | $128.82 | $151.36 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $275.42 / $323.59
| Professional | | $213.80 | $275.42 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $758.58
| Facility | | $660.69 | $660.69 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $257.04 / $537.03
| Professional | | $128.82 | $257.04 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $309.03 / $676.08
| Professional | | $117.49 | $309.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $812.83
| Professional | 22 | $371.54 | $371.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $239.88
| Professional | 53 | $109.65 | $109.65 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,715.35 / $3,715.35
| Facility | | $3,235.94 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $346.74 / $389.05
| Professional | | $158.49 | $346.74 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,995.26 / $3,090.30
| Facility | | $575.44 | $1,995.26 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $223.87 / $512.86
| Professional | | $104.71 | $223.87 | $512.86 |