- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $645.65 / $1,174.90
| Facility | | $38.90 | $645.65 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $38.02 / $104.71
| Professional | | $10.96 | $38.02 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $12.30 / $33.88 / $72.44
| Professional | 52 | $12.30 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $18.62 / $70.79
| Professional | | $9.33 | $18.62 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $36.31 / $61.66
| Professional | | $15.85 | $36.31 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $16.60 / $21.88
| Facility | | $14.13 | $16.60 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $51.29
| Professional | | $32.36 | $36.31 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $39.81 / $75.86
| Professional | | $13.49 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $37.15 / $74.13
| Professional | | $11.22 | $37.15 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $9.12 / $28.18 / $102.33
| Professional | 52 | $9.12 | $28.18 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $4,168.69 / $4,168.69
| Facility | | $912.01 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $66.07 / $102.33
| Professional | | $56.23 | $66.07 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $48.98
| Facility | | $44.67 | $44.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $35.48 / $74.13
| Professional | | $12.30 | $35.48 | $74.13 |