- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $467.74 / $1,905.46
| Facility | | $28.84 | $467.74 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $30.20 / $70.79
| Professional | | $10.00 | $30.20 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $11.75 / $14.79
| Professional | | $8.32 | $11.75 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $851.14
| Facility | | $436.52 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $37.15 / $51.29
| Professional | | $11.48 | $37.15 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $41.69 / $58.88
| Professional | | $13.80 | $41.69 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $26.92 / $52.48
| Facility | | $9.77 | $26.92 | $52.48 |
- 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
- $34.67 / $46.77 / $245.47
| Professional | | $34.67 | $46.77 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $36.31 / $46.77
| Facility | | $12.30 | $36.31 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $28.84 / $53.70
| Professional | | $10.96 | $28.84 | $53.70 |