- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $2,089.30 / $6,456.54
| Facility | | $371.54 | $2,089.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $912.01 / $3,090.30 / $7,244.36
| Facility | 50 | $912.01 | $3,090.30 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $1,995.26
| Facility | 52 | $416.87 | $575.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $234.42 / $724.44
| Professional | | $102.33 | $234.42 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,630.78 / $9,332.54
| Facility | | $1,513.56 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $323.59 / $1,023.29
| Professional | | $114.82 | $323.59 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $933.25 / $2,818.38
| Facility | | $165.96 | $933.25 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | 52 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Facility | 53 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $316.23 / $912.01
| Professional | | $128.82 | $316.23 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,778.28 / $4,365.16
| Facility | | $537.03 | $1,778.28 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $281.84 / $870.96
| Professional | | $109.65 | $281.84 | $870.96 |