- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $199.53 / $588.84
| Facility | | $0.65 | $199.53 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $39.81 / $147.91
| Professional | | $12.02 | $39.81 | $147.91 |
- 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
- $10.47 / $14.45 / $50.12
| Professional | | $10.47 | $14.45 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $173.78 / $338.84
| Facility | | $67.61 | $173.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $34.67 / $72.44
| Professional | | $13.49 | $34.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $36.31 / $67.61
| Professional | | $13.18 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $58.88 / $218.78
| Professional | | $16.22 | $58.88 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.79 / $47.86
| Professional | | $14.13 | $14.79 | $47.86 |
- 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
- $35.48 / $42.66 / $64.57
| Facility | | $35.48 | $42.66 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $36.31 / $66.07
| Professional | | $12.30 | $36.31 | $66.07 |