- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $181.97 / $338.84
| Facility | | $33.88 | $181.97 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $199.53
| Facility | 52 | $158.49 | $158.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.90 / $138.04
| Professional | | $30.20 | $38.90 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $67.61 / $213.80 / $281.84
| Professional | 22 | $67.61 | $213.80 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $28.84 / $45.71 / $120.23
| Professional | 52 | $28.84 | $45.71 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $48.98
| Professional | | $30.20 | $35.48 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $45.71 / $53.70
| Professional | | $35.48 | $45.71 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $57.54 / $75.86
| Facility | | $52.48 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $72.44
| Professional | | $28.18 | $44.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $186.21
| Professional | | $27.54 | $47.86 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $64.57
| Professional | | $28.18 | $38.90 | $64.57 |