- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $323.59 / $812.83
| Facility | | $13.49 | $323.59 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $38.90 / $138.04
| Professional | | $10.96 | $38.90 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $24.55 / $25.70 / $33.88
| Professional | 52 | $24.55 | $25.70 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $26.92 / $85.11
| Professional | | $10.00 | $26.92 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $32.36 / $54.95
| Professional | | $11.48 | $32.36 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $36.31 / $52.48
| Professional | | $10.47 | $36.31 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Facility | | $19.05 | $19.05 | $19.05 |
- 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
- $12.88 / $37.15 / $79.43
| Professional | | $12.88 | $37.15 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $35.48 / $75.86
| Facility | | $12.30 | $35.48 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | 52 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $61.66 / $245.47
| Professional | | $38.02 | $61.66 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $39.81 / $56.23
| Facility | | $35.48 | $39.81 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $36.31 / $69.18
| Professional | | $12.30 | $36.31 | $69.18 |