- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $165.96 / $436.52
| Facility | | $40.74 | $165.96 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $75.86 / $151.36 / $158.49
| Facility | 52 | $75.86 | $151.36 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $87.10
| Professional | | $30.20 | $38.02 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $85.11 / $158.49 / $229.09
| Professional | 22 | $85.11 | $158.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $21.38 / $42.66 / $109.65
| Professional | 52 | $21.38 | $42.66 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $165.96 / $524.81
| Facility | | $87.10 | $165.96 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $93.33
| Professional | | $31.62 | $45.71 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $114.82
| Facility | | $34.67 | $47.86 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Facility | 52 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $46.77 / $93.33
| Professional | | $28.84 | $46.77 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $66.07
| Facility | | $30.20 | $38.02 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $69.18
| Professional | | $26.30 | $38.02 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Professional | 22 | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | 52 | $60.26 | $60.26 | $60.26 |