- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $323.59 / $323.59
| Facility | | $316.23 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | 52 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $37.15 / $66.07
| Professional | | $28.84 | $37.15 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | 22 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.95 / $22.39 / $50.12
| Professional | 52 | $19.95 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $34.67 / $45.71
| Professional | | $30.20 | $34.67 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | 22 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $8.71 / $10.72 / $17.38
| Professional | 52 | $8.71 | $10.72 | $17.38 |
- 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
- $22.91 / $25.70 / $29.51
| Professional | | $22.91 | $25.70 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $69.18
| Professional | | $34.67 | $41.69 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $28.84 / $33.88
| Facility | | $25.70 | $28.84 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $42.66 / $46.77
| Facility | | $8.71 | $42.66 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $72.44
| Professional | | $30.20 | $41.69 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | 52 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $288.40 / $295.12
| Professional | | $42.66 | $288.40 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $66.07
| Facility | | $26.30 | $36.31 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | 52 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $36.31 / $63.10
| Professional | | $28.18 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | 22 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.50 / $22.39 / $50.12
| Professional | 52 | $19.50 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $32.36 / $33.11
| Professional | | $30.20 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $48.98 / $95.50
| Professional | | $26.30 | $48.98 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $64.57
| Facility | | $26.30 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $40.74 / $74.13
| Professional | | $29.51 | $40.74 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $61.66
| Professional | | $25.12 | $35.48 | $61.66 |
- 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
- Typical Low / Median / Typical High
- $34.67 / $36.31 / $36.31
| Professional | | $34.67 | $36.31 | $36.31 |