- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $1,905.46 / $5,248.07
| Facility | | $245.47 | $1,905.46 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,137.96 / $2,951.21 / $4,466.84
| Facility | 50 | $2,137.96 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $269.15 / $933.25
| Professional | | $104.71 | $269.15 | $933.25 |
- 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
- $154.88 / $407.38 / $1,778.28
| Professional | 50 | $154.88 | $407.38 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $97.72
| Professional | 53 | $51.29 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $323.59 / $724.44
| Professional | | $169.82 | $323.59 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $281.84 / $794.33
| Professional | | $104.71 | $281.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $512.86 / $2,951.21
| Facility | | $165.96 | $512.86 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $2,511.89
| Facility | 50 | $954.99 | $954.99 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 53 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $467.74 / $1,905.46
| Professional | | $234.42 | $467.74 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $645.65
| Professional | | $263.03 | $537.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $426.58 / $616.60
| Professional | | $223.87 | $426.58 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $239.88 / $537.03
| Professional | | $102.33 | $239.88 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,238.72 / $5,128.61
| Facility | | $1,288.25 | $2,238.72 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $257.04 / $602.56
| Professional | | $114.82 | $257.04 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $371.54 / $549.54
| Professional | | $213.80 | $371.54 | $549.54 |