- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,445.44 / $3,090.30
| Facility | | $239.88 | $1,445.44 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $602.56 / $1,819.70 / $2,570.40
| Facility | 50 | $602.56 | $1,819.70 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $239.88 / $707.95
| Professional | | $107.15 | $239.88 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $190.55
| Professional | 22 | $141.25 | $141.25 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $177.83 / $426.58 / $1,174.90
| Professional | 50 | $177.83 | $426.58 | $1,174.90 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,862.09 / $32,359.37
| Facility | | $257.04 | $1,862.09 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 53 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $281.84 / $831.76
| Professional | | $117.49 | $281.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $302.00
| Facility | | $128.82 | $128.82 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $74.13
| Facility | 53 | $32.36 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $295.12 / $645.65
| Professional | | $128.82 | $295.12 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $41.69 / $93.33 / $169.82
| Professional | 53 | $41.69 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $257.04 / $616.60
| Professional | | $120.23 | $257.04 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $3,311.31
| Facility | | $100.00 | $141.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $371.54 / $478.63
| Professional | | $302.00 | $371.54 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,511.89 / $7,079.46
| Facility | | $1,288.25 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $269.15 / $691.83
| Professional | | $120.23 | $269.15 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,905.46 / $2,818.38
| Facility | | $1,096.48 | $1,905.46 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $239.88 / $389.05
| Professional | | $229.09 | $239.88 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,862.09 / $32,359.37
| Facility | | $257.04 | $1,862.09 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 53 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $281.84 / $831.76
| Professional | | $117.49 | $281.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $407.38 / $831.76
| Facility | | $81.28 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $467.74
| Professional | | $190.55 | $263.03 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,344.23 / $5,623.41
| Facility | | $954.99 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $288.40 / $707.95
| Professional | | $123.03 | $288.40 | $707.95 |