- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $79.43
| Professional | | $30.20 | $38.02 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $181.97 / $204.17 / $229.09
| Professional | 22 | $181.97 | $204.17 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $85.11
| Professional | 52 | $28.18 | $39.81 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Professional | | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $79.43
| Professional | | $39.81 | $47.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $48.98
| Professional | | $26.92 | $37.15 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $128.82
| Facility | | $30.90 | $37.15 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $72.44
| Professional | | $28.18 | $42.66 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $87.10
| Facility | | $28.18 | $40.74 | $87.10 |
- 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
- $33.11 / $52.48 / $281.84
| Professional | | $33.11 | $52.48 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Professional | 52 | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $67.61
| Professional | | $27.54 | $38.90 | $67.61 |