- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $218.78 / $758.58
| Facility | | $36.31 | $218.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $39.81 / $144.54
| Professional | | $11.22 | $39.81 | $144.54 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $17.38 / $66.07
| Professional | | $8.71 | $17.38 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $54.95 / $102.33
| Professional | | $17.38 | $54.95 | $102.33 |
- 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
- $13.49 / $39.81 / $89.13
| Professional | | $13.49 | $39.81 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Professional | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $30.20 / $63.10
| Facility | | $11.75 | $30.20 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $102.33
| Professional | | $36.31 | $36.31 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $2,570.40
| Facility | | $1,318.26 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Professional | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $63.10
| Facility | | $36.31 | $48.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $34.67 / $70.79
| Professional | | $11.75 | $34.67 | $70.79 |
- 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
- $245.47 / $245.47 / $302.00
| Professional | | $245.47 | $245.47 | $302.00 |