- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $257.04 / $1,202.26
| Facility | | $40.74 | $257.04 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $39.81 / $147.91
| Professional | | $10.96 | $39.81 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $79.43 / $416.87
| Facility | | $8.32 | $79.43 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $52.48 / $131.83
| Professional | | $20.89 | $52.48 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $338.84
| Facility | | $97.72 | $141.25 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Facility | 52 | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $48.98 / $138.04
| Professional | | $17.38 | $48.98 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $128.82 / $263.03
| Facility | | $107.15 | $128.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $47.86 / $125.89
| Professional | | $24.55 | $47.86 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $37.15 / $117.49
| Facility | | $12.59 | $37.15 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $74.13 / $245.47
| Professional | | $40.74 | $74.13 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $37.15
| Facility | | $11.22 | $11.22 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $40.74 / $107.15
| Professional | | $12.88 | $40.74 | $107.15 |