- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $134.90 / $331.13
| Professional | | $58.88 | $134.90 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $28.84 / $138.04 / $281.84
| Professional | 25 | $28.84 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $128.82 / $288.40
| Professional | | $102.33 | $128.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $107.15 / $120.23 / $151.36
| Professional | 25 | $107.15 | $120.23 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $354.81
| Professional | | $70.79 | $120.23 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $93.33 / $245.47
| Professional | | $53.70 | $93.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $117.49 / $245.47
| Professional | | $66.07 | $117.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $77.62 / $194.98
| Professional | | $38.02 | $77.62 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $125.89 / $218.78
| Professional | | $63.10 | $125.89 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $794.33 / $1,023.29
| Professional | | $112.20 | $794.33 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $104.71 / $724.44
| Professional | | $48.98 | $104.71 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $194.98
| Facility | | $60.26 | $102.33 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $123.03 / $263.03
| Professional | | $67.61 | $123.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $416.87
| Professional | | $257.04 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $181.97
| Professional | | $64.57 | $79.43 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $181.97
| Professional | | $54.95 | $89.13 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $85.11
| Professional | 25 | $75.86 | $75.86 | $85.11 |