- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.90 / $67.61
| Professional | | $30.20 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Professional | 22 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $33.88 / $43.65 / $77.62
| Professional | 52 | $33.88 | $43.65 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $34.67
| Professional | | $31.62 | $31.62 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.20 / $38.90
| Professional | | $25.70 | $30.20 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $75.86
| Professional | | $27.54 | $38.02 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $35.48 / $52.48
| Facility | | $27.54 | $35.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 52 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $281.84
| Professional | | $32.36 | $51.29 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | 22 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Professional | 52 | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.02 / $58.88
| Professional | | $28.18 | $38.02 | $58.88 |