- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $1,698.24 / $2,511.89
| Facility | | $181.97 | $1,698.24 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,380.38 / $2,041.74 / $4,265.80
| Facility | 50 | $1,380.38 | $2,041.74 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $239.88 / $707.95
| Professional | | $104.71 | $239.88 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $141.25 / $478.63 / $1,548.82
| Professional | 22 | $141.25 | $478.63 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $380.19 / $1,348.96
| Professional | 50 | $158.49 | $380.19 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $186.21
| Professional | 53 | $138.04 | $138.04 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $199.53 / $446.68
| Professional | | $97.72 | $199.53 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $147.91 / $165.96 / $354.81
| Professional | 50 | $147.91 | $165.96 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $389.05
| Professional | | $173.78 | $251.19 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $588.84
| Professional | 50 | $263.03 | $263.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $162.18 / $229.09
| Facility | | $125.89 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $302.00 / $512.86
| Professional | | $213.80 | $302.00 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $204.17 / $407.38
| Professional | | $97.72 | $204.17 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $1,548.82 / $2,398.83
| Facility | | $181.97 | $1,548.82 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $1,949.84 / $4,073.80
| Facility | 50 | $794.33 | $1,949.84 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $263.03 / $562.34
| Professional | | $109.65 | $263.03 | $562.34 |
- 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
- $165.96 / $380.19 / $1,047.13
| Professional | 50 | $165.96 | $380.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $186.21
| Professional | 53 | $138.04 | $138.04 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $190.55 / $407.38
| Professional | | $93.33 | $190.55 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,621.81 / $3,801.89
| Facility | | $707.95 | $1,621.81 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $204.17 / $346.74
| Professional | | $114.82 | $204.17 | $346.74 |