- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $2,511.89 / $8,317.64
| Facility | | $229.09 | $2,511.89 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | 22 | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,513.56 / $3,019.95 / $8,709.64
| Facility | 50 | $1,513.56 | $3,019.95 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $229.09 / $707.95
| Professional | | $112.20 | $229.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $169.82 / $389.05 / $1,258.93
| Professional | 50 | $169.82 | $389.05 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,715.35 / $9,332.54
| Facility | | $1,513.56 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $204.17 / $371.54
| Professional | | $109.65 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $309.03 / $549.54
| Professional | 50 | $158.49 | $309.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $549.54 / $1,862.09
| Facility | | $177.83 | $549.54 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | 22 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $251.19 / $562.34
| Professional | | $128.82 | $251.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,819.70 / $4,365.16
| Facility | | $660.69 | $1,819.70 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $218.78 / $457.09
| Professional | | $107.15 | $218.78 | $457.09 |