- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $4,073.80 / $10,000.00
| Facility | | $562.34 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $4,466.84 / $10,232.93
| Facility | 50 | $794.33 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,570.40 / $2,951.21 / $8,511.38
| Facility | 52 | $2,570.40 | $2,951.21 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $1,122.02
| Professional | | $281.84 | $389.05 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $6,309.57 / $12,589.25
| Facility | | $2,570.40 | $6,309.57 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $776.25
| Professional | | $281.84 | $416.87 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,513.56 / $12,589.25
| Facility | | $602.56 | $1,513.56 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 22 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | 52 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | 53 | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $457.09 / $954.99
| Professional | | $288.40 | $457.09 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,168.69 / $9,772.37
| Facility | | $1,737.80 | $4,168.69 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $398.11 / $724.44
| Professional | | $269.15 | $398.11 | $724.44 |