- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $3,090.30 / $8,511.38
| Facility | | $501.19 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,019.95 / $5,623.41 / $11,748.98
| Facility | 50 | $3,019.95 | $5,623.41 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,584.89 / $1,621.81 / $2,398.83
| Facility | 52 | $1,584.89 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | 53 | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $616.60 / $1,548.82
| Professional | | $199.53 | $616.60 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $4,365.16 / $10,471.29
| Facility | | $1,698.24 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $794.33 / $1,949.84
| Professional | | $234.42 | $794.33 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $2,951.21 / $8,128.31
| Facility | | $346.74 | $2,951.21 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | 52 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Facility | 53 | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $707.95 / $2,089.30
| Professional | | $239.88 | $707.95 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,981.07 / $9,120.11
| Facility | | $1,584.89 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $724.44 / $1,659.59
| Professional | | $208.93 | $724.44 | $1,659.59 |