- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,258.93 / $3,388.44
| Facility | | $177.83 | $1,258.93 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $933.25 / $1,698.24 / $5,370.32
| Facility | 50 | $933.25 | $1,698.24 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $218.78 / $630.96
| Professional | | $102.33 | $218.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $1,230.27
| Professional | 22 | $141.25 | $190.55 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $154.88 / $346.74 / $1,258.93
| Professional | 50 | $154.88 | $346.74 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $125.89
| Professional | 53 | $63.10 | $63.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $131.83 / $251.19
| Professional | | $87.10 | $131.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $309.03 / $537.03
| Professional | 50 | $131.83 | $309.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,137.96 / $2,951.21
| Facility | | $1,258.93 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $316.23
| Professional | | $77.62 | $95.50 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $141.25 / $467.74
| Professional | 50 | $117.49 | $141.25 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $173.78
| Facility | | $104.71 | $138.04 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $257.04 / $309.03
| Professional | | $128.82 | $257.04 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $1,318.26
| Facility | | $186.21 | $186.21 | $1,318.26 |
- 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 / $288.40 / $1,445.44
| Professional | | $123.03 | $288.40 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $154.88
| Professional | | $32.36 | $33.11 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,445.44 / $2,630.27
| Facility | | $389.05 | $1,445.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $208.93 / $416.87
| Professional | | $104.71 | $208.93 | $416.87 |