- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $128.82 / $575.44
| Facility | | $19.95 | $128.82 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $38.02 / $107.15
| Professional | | $10.96 | $38.02 | $107.15 |
- 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
- $8.32 / $12.88 / $47.86
| Professional | | $8.32 | $12.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $31.62 / $58.88
| Professional | | $12.02 | $31.62 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.45 / $19.50
| Facility | | $10.96 | $14.45 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.02 / $53.70
| Professional | | $33.11 | $38.02 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $35.48 / $69.18
| Professional | | $12.88 | $35.48 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $194.98 / $524.81
| Facility | | $32.36 | $194.98 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $34.67 / $67.61
| Professional | | $13.18 | $34.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $32.36 / $33.11
| Professional | | $10.47 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $30.90 / $66.07
| Professional | | $10.47 | $30.90 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $39.81 / $46.77
| Facility | | $35.48 | $39.81 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $30.90 / $61.66
| Professional | | $11.22 | $30.90 | $61.66 |