- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,862.09 / $5,623.41
| Facility | | $151.36 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,096.48 / $3,311.31 / $6,760.83
| Facility | 50 | $1,096.48 | $3,311.31 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $251.19 / $870.96
| Professional | | $107.15 | $251.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $1,548.82
| Professional | 22 | $478.63 | $478.63 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $407.38 / $1,047.13
| Professional | 50 | $162.18 | $407.38 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | 53 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $245.47
| Professional | | $93.33 | $131.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $363.08
| Professional | 50 | $144.54 | $213.80 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $4,265.80 / $8,317.64
| Facility | | $1,819.70 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $102.33 / $213.80
| Professional | | $87.10 | $102.33 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $154.88 / $323.59
| Professional | 50 | $131.83 | $154.88 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $125.89 / $147.91
| Facility | | $102.33 | $125.89 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $281.84 / $316.23
| Professional | | $218.78 | $281.84 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $239.88 / $524.81
| Professional | | $114.82 | $239.88 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,951.21 / $4,265.80
| Facility | | $741.31 | $2,951.21 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $194.98 / $416.87
| Professional | | $100.00 | $194.98 | $416.87 |