- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $112.20 / $112.20
| Facility | | $44.67 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $97.72
| Professional | | $25.12 | $38.90 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $30.90 / $79.43 / $173.78
| Professional | 25 | $30.90 | $79.43 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Professional | 52 | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $72.44
| Professional | | $30.90 | $42.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $56.23 / $117.49
| Professional | | $24.55 | $56.23 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.90 / $69.18
| Facility | | $26.30 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $66.07 / $245.47
| Professional | | $37.15 | $66.07 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $60.26 / $89.13
| Professional | | $42.66 | $60.26 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $72.44 / $104.71
| Professional | | $34.67 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $85.11
| Professional | | $26.92 | $47.86 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $42.66 / $208.93
| Facility | | $22.91 | $42.66 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $87.10
| Professional | | $30.90 | $52.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $89.13
| Professional | | $52.48 | $63.10 | $89.13 |