- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $3,235.94 / $7,413.10
| Facility | | $446.68 | $3,235.94 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,570.88 / $4,677.35 / $4,677.35
| Facility | 50 | $4,570.88 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | 52 | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $446.68 / $812.83
| Professional | | $275.42 | $446.68 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $269.15
| Professional | | $263.03 | $263.03 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,570.88 / $8,912.51
| Facility | | $2,238.72 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $407.38 / $602.56
| Professional | | $331.13 | $407.38 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $302.00 / $489.78
| Professional | | $269.15 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $660.69
| Professional | | $223.87 | $407.38 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,513.56 / $26,302.68
| Facility | | $346.74 | $1,513.56 | $26,302.68 |
- 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
- $316.23 / $489.78 / $2,884.03
| Professional | | $316.23 | $489.78 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,818.38 / $4,365.16
| Facility | | $1,819.70 | $2,818.38 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $426.58 / $676.08
| Professional | | $295.12 | $426.58 | $676.08 |