- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $147.91 / $2,570.40
| Facility | | $33.88 | $147.91 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $60.26 / $128.82
| Professional | | $25.12 | $60.26 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $67.61 / $70.79
| Professional | | $57.54 | $67.61 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $10,715.19 / $11,220.18
| Facility | | $3,801.89 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $60.26 / $114.82
| Professional | | $25.70 | $60.26 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $42.66
| Facility | | $22.39 | $32.36 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $57.54 / $79.43
| Professional | | $27.54 | $57.54 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $42.66 / $42.66
| Facility | | $34.67 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Facility | 52 | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $87.10 / $575.44
| Professional | | $33.11 | $87.10 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $724.44 / $1,949.84
| Facility | | $58.88 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $54.95 / $117.49
| Professional | | $26.30 | $54.95 | $117.49 |