- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $489.78 / $660.69
| Facility | | $194.98 | $489.78 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Facility | 52 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $141.25 / $275.42
| Professional | | $81.28 | $141.25 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $208.93
| Professional | 52 | $69.18 | $69.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $24.55 / $67.61 / $77.62
| Professional | 53 | $24.55 | $67.61 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $109.65
| Facility | | $66.07 | $83.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $218.78 / $223.87
| Professional | | $74.13 | $218.78 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $107.15 / $107.15
| Facility | | $34.67 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | 52 | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Facility | 53 | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $724.44
| Professional | | $70.79 | $120.23 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $812.83
| Facility | | $251.19 | $446.68 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Facility | 52 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $144.54 / $144.54
| Professional | | $83.18 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $562.34
| Facility | | $457.09 | $457.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $169.82
| Professional | | $61.66 | $102.33 | $169.82 |