- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $141.25
| Professional | | $30.20 | $39.81 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Professional | 22 | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $89.13
| Professional | 52 | $27.54 | $44.67 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $64.57
| Facility | | $33.88 | $42.66 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $120.23
| Professional | | $30.90 | $51.29 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $85.11
| Professional | | $37.15 | $43.65 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $18.62 / $21.38 / $45.71
| Professional | 52 | $18.62 | $21.38 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $52.48 / $54.95
| Facility | | $50.12 | $52.48 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $91.20
| Professional | | $28.84 | $51.29 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $28.84 / $48.98
| Facility | | $16.22 | $28.84 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $40.74 / $60.26
| Professional | | $22.91 | $40.74 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $87.10
| Professional | | $26.92 | $45.71 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $87.10
| Facility | | $54.95 | $56.23 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $93.33
| Professional | | $54.95 | $56.23 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $64.57
| Facility | | $33.88 | $42.66 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $120.23
| Professional | | $30.90 | $51.29 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $27.54
| Facility | | $23.44 | $23.44 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $70.79
| Professional | | $30.90 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $87.10
| Professional | | $28.18 | $43.65 | $87.10 |