- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $489.78 / $1,148.15
| Facility | | $23.99 | $489.78 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $39.81 / $141.25
| Professional | | $10.47 | $39.81 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.30 / $70.79
| Professional | | $21.38 | $26.30 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,584.89 / $3,090.30
| Facility | | $1,230.27 | $1,584.89 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $25.70 / $69.18
| Professional | | $11.22 | $25.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $34.67 / $102.33
| Professional | | $12.88 | $34.67 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $38.90 / $69.18
| Facility | | $12.30 | $38.90 | $69.18 |
- 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
- $42.66 / $72.44 / $107.15
| Professional | | $42.66 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $69.18 / $91.20
| Professional | | $23.44 | $69.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $87.10
| Professional | | $25.12 | $30.90 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,202.26 / $1,230.27
| Facility | | $1,047.13 | $1,202.26 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $102.33
| Professional | | $58.88 | $58.88 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $44.67
| Facility | | $42.66 | $42.66 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $40.74 / $87.10
| Professional | | $14.79 | $40.74 | $87.10 |