- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,187.76 / $7,943.28
| Facility | | $489.78 | $2,187.76 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $2,187.76 / $3,630.78
| Facility | 50 | $416.87 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | 53 | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $295.12 / $1,380.38
| Professional | | $102.33 | $295.12 | $1,380.38 |
- 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 / $630.96 / $891.25
| Professional | 50 | $158.49 | $630.96 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $97.72
| Professional | 53 | $51.29 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $186.21 / $562.34
| Professional | | $93.33 | $186.21 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $346.74 / $912.01
| Professional | 50 | $141.25 | $346.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,905.46 / $3,801.89
| Facility | | $1,513.56 | $1,905.46 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $229.09 / $478.63
| Professional | | $128.82 | $229.09 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $446.68 / $724.44
| Professional | | $223.87 | $446.68 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $416.87 / $2,137.96
| Facility | | $169.82 | $416.87 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $269.15 / $512.86 / $2,089.30
| Facility | 50 | $269.15 | $512.86 | $2,089.30 |
- 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
- $239.88 / $446.68 / $4,073.80
| Professional | | $239.88 | $446.68 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $524.81 / $660.69
| Professional | | $239.88 | $524.81 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $537.03 / $776.25
| Professional | | $218.78 | $537.03 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $239.88 / $537.03
| Professional | | $102.33 | $239.88 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,548.82 / $5,248.07
| Facility | | $1,096.48 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $281.84 / $588.84
| Professional | | $141.25 | $281.84 | $588.84 |