- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $44.67 / $165.96
| Facility | | $23.99 | $44.67 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $51.29 / $123.03 / $223.87
| Facility | 25 | $51.29 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $134.90 / $295.12
| Professional | | $60.26 | $134.90 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $30.90 / $138.04 / $223.87
| Professional | 25 | $30.90 | $138.04 | $223.87 |
- 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
- $117.49 / $117.49 / $229.09
| Professional | | $117.49 | $117.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $204.17 / $295.12
| Professional | | $100.00 | $204.17 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $144.54 / $213.80
| Professional | 50 | $114.82 | $144.54 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Facility | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $173.78
| Professional | | $64.57 | $104.71 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $70.79 / $154.88
| Professional | | $39.81 | $70.79 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $125.89 / $204.17
| Professional | | $91.20 | $125.89 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Facility | | $79.43 | $79.43 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $72.44 / $79.43 / $91.20
| Facility | 25 | $72.44 | $79.43 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $141.25
| Professional | | $107.15 | $114.82 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $114.82
| Professional | 25 | $107.15 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $229.09
| Professional | | $117.49 | $117.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $100.00 / $158.49
| Professional | | $63.10 | $100.00 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $91.20 / $251.19
| Professional | | $87.10 | $91.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $77.62 / $309.03
| Professional | | $11.48 | $77.62 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $154.88
| Professional | | $52.48 | $89.13 | $154.88 |