- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $2,089.30 / $4,265.80
| Facility | | $281.84 | $2,089.30 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,041.74 / $3,467.37 / $5,128.61
| Facility | 50 | $2,041.74 | $3,467.37 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $263.03 / $1,122.02
| Professional | | $104.71 | $263.03 | $1,122.02 |
- 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
- $151.36 / $354.81 / $1,023.29
| Professional | 50 | $151.36 | $354.81 | $1,023.29 |
- 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
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $630.96
| Professional | | $162.18 | $295.12 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $660.69
| Professional | | $199.53 | $288.40 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $323.59 / $1,819.70
| Facility | | $131.83 | $323.59 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,041.74 / $3,467.37 / $5,128.61
| Facility | 50 | $2,041.74 | $3,467.37 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $354.81 / $616.60
| Professional | | $173.78 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Professional | 22 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $354.81 / $977.24
| Professional | 50 | $151.36 | $354.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $446.68 / $489.78
| Facility | | $269.15 | $446.68 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $275.42 / $549.54
| Facility | | $125.89 | $275.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $288.40 / $616.60
| Professional | | $79.43 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,884.03 / $3,630.78
| Facility | | $2,290.87 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,388.44 / $4,365.16 / $5,495.41
| Facility | 50 | $3,388.44 | $4,365.16 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $346.74 / $645.65
| Professional | | $208.93 | $346.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,951.21 / $4,897.79
| Facility | | $1,548.82 | $2,951.21 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $316.23 / $575.44
| Professional | | $162.18 | $316.23 | $575.44 |