- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $144.54 / $371.54
| Facility | | $109.65 | $144.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $141.25 / $288.40
| Professional | | $95.50 | $141.25 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Professional | 25 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $165.96
| Professional | | $95.50 | $125.89 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $97.72 / $186.21
| Professional | | $0.79 | $97.72 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $190.55
| Facility | | $169.82 | $169.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $213.80
| Professional | | $169.82 | $169.82 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $162.18 / $234.42
| Facility | | $79.43 | $162.18 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $281.84
| Professional | | $85.11 | $134.90 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.10 / $75.86
| Facility | | $0.10 | $0.10 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $72.44 / $112.20
| Professional | | $67.61 | $72.44 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $120.23 / $151.36
| Facility | | $69.18 | $120.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $316.23
| Professional | | $107.15 | $162.18 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $95.50 / $162.18
| Professional | | $89.13 | $95.50 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $158.49 / $501.19
| Facility | | $125.89 | $158.49 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $138.04 / $158.49
| Professional | | $128.82 | $138.04 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $144.54 / $316.23
| Professional | | $89.13 | $144.54 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $138.04 / $190.55
| Professional | | $81.28 | $138.04 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $97.72 / $436.52
| Facility | | $79.43 | $97.72 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $151.36 / $281.84
| Professional | | $102.33 | $151.36 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $165.96
| Facility | | $69.18 | $128.82 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $165.96 / $316.23
| Professional | | $107.15 | $165.96 | $316.23 |