- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,801.89 / $7,413.10
| Facility | | $2,041.74 | $3,801.89 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,162.28 / $5,623.41 / $5,623.41
| Facility | 50 | $3,162.28 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $457.09 / $1,479.11
| Professional | | $295.12 | $457.09 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $269.15
| Professional | | $234.42 | $234.42 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $2,754.23 / $5,128.61
| Facility | | $630.96 | $2,754.23 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $275.42 / $1,202.26
| Professional | | $245.47 | $275.42 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $630.96
| Professional | | $288.40 | $380.19 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $489.78 / $5,128.61
| Facility | | $302.00 | $489.78 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $616.60 / $7,079.46 / $7,079.46
| Facility | 52 | $616.60 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $154.88 / $1,778.28 / $1,778.28
| Facility | 53 | $154.88 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $363.08 / $2,884.03
| Professional | | $275.42 | $363.08 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,019.95 / $5,370.32
| Facility | | $2,137.96 | $3,019.95 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $331.13 / $588.84
| Professional | | $269.15 | $331.13 | $588.84 |