- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,949.84 / $3,090.30
| Facility | | $251.19 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,288.25 / $2,630.27 / $4,365.16
| Facility | 50 | $1,288.25 | $2,630.27 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $239.88 / $851.14
| Professional | | $104.71 | $239.88 | $851.14 |
- 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
- $158.49 / $346.74 / $1,348.96
| Professional | 50 | $158.49 | $346.74 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $37.15
| Professional | 53 | $36.31 | $36.31 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,737.80 / $4,073.80
| Facility | | $660.69 | $1,737.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,089.30 / $3,388.44 / $9,549.93
| Facility | 50 | $2,089.30 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $870.96
| Professional | | $199.53 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $602.56 / $1,318.26
| Professional | 50 | $302.00 | $602.56 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $933.25 / $2,238.72
| Facility | | $660.69 | $933.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $478.63 / $1,047.13
| Professional | | $234.42 | $478.63 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $1,737.80
| Facility | | $707.95 | $870.96 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $851.14
| Professional | | $245.47 | $436.52 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $758.58 / $2,344.23
| Facility | | $151.36 | $758.58 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,288.25 / $2,398.83 / $3,630.78
| Facility | 50 | $1,288.25 | $2,398.83 | $3,630.78 |
- 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 / $478.63 / $1,047.13
| Professional | | $234.42 | $478.63 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Professional | 53 | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,238.72 / $3,981.07
| Facility | | $1,000.00 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $316.23 / $741.31
| Professional | | $144.54 | $316.23 | $741.31 |