- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,584.89 / $3,090.30
| Facility | | $239.88 | $1,584.89 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $4,365.16
| Facility | 50 | $1,288.25 | $1,288.25 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $234.42 / $676.08
| Professional | | $104.71 | $234.42 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $354.81 / $1,258.93
| Professional | 50 | $158.49 | $354.81 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $309.03 / $602.56
| Professional | | $213.80 | $309.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $257.04 / $371.54 / $724.44
| Professional | 22 | $257.04 | $371.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $467.74 / $912.01
| Professional | 50 | $323.59 | $467.74 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $346.74 / $676.08
| Professional | | $162.18 | $346.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $416.87 / $1,548.82
| Facility | | $112.20 | $416.87 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,949.84 / $2,344.23 / $2,454.71
| Facility | 50 | $1,949.84 | $2,344.23 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $407.38 / $4,073.80
| Professional | | $245.47 | $407.38 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,819.70 / $2,570.40
| Facility | | $1,778.28 | $1,819.70 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $269.15 / $549.54
| Professional | | $128.82 | $269.15 | $549.54 |