- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $154.88 / $158.49
| Facility | | $79.43 | $154.88 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $72.44
| Professional | | $30.20 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.50 / $39.81 / $44.67
| Professional | 52 | $19.50 | $39.81 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $31.62 / $44.67
| Professional | | $26.30 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $8.51
| Professional | 52 | $7.76 | $7.76 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $83.18
| Facility | | $77.62 | $77.62 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $60.26 / $338.84
| Facility | | $47.86 | $60.26 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $69.18
| Professional | | $30.20 | $43.65 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $72.44
| Facility | | $28.18 | $37.15 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 52 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $52.48 / $281.84
| Professional | | $33.11 | $52.48 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $63.10
| Professional | | $28.84 | $40.74 | $63.10 |