- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $416.87 / $776.25
| Facility | | $27.54 | $416.87 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $316.23 / $331.13 / $389.05
| Facility | 52 | $316.23 | $331.13 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $39.81 / $154.88
| Professional | | $10.96 | $39.81 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $12.30 / $63.10 / $72.44
| Professional | 52 | $12.30 | $63.10 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | 52 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $40.74 / $190.55
| Professional | | $12.88 | $40.74 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $30.20
| Facility | | $13.18 | $13.18 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $42.66 / $91.20
| Professional | | $14.79 | $42.66 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $11.75 / $28.84
| Facility | | $5.62 | $11.75 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $38.90 / $70.79
| Professional | | $20.89 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $38.02 / $89.13
| Professional | | $12.02 | $38.02 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $575.44 / $707.95
| Facility | | $223.87 | $575.44 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $66.07
| Professional | | $24.55 | $28.84 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | 52 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $40.74 / $190.55
| Professional | | $12.88 | $40.74 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $57.54
| Professional | | $33.11 | $33.11 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $63.10
| Facility | | $33.88 | $50.12 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $39.81 / $95.50
| Professional | | $12.59 | $39.81 | $95.50 |