- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $141.25 / $363.08
| Facility | | $66.07 | $141.25 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $831.76
| Facility | 25 | $204.17 | $269.15 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $239.88
| Professional | | $66.07 | $107.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $69.18 / $123.03 / $275.42
| Professional | 25 | $69.18 | $123.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $109.65 / $144.54
| Professional | | $72.44 | $109.65 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $87.10 / $112.20 / $141.25
| Professional | 25 | $87.10 | $112.20 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $288.40
| Facility | | $91.20 | $91.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $109.65
| Professional | | $66.07 | $83.18 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $426.58 / $426.58
| Facility | | $144.54 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $194.98
| Professional | | $81.28 | $117.49 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $77.62 / $114.82
| Facility | | $70.79 | $77.62 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $169.82 / $234.42
| Facility | | $125.89 | $169.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $181.97
| Professional | | $79.43 | $112.20 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $512.86 / $512.86
| Facility | | $120.23 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $131.83 / $691.83
| Professional | | $95.50 | $131.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $190.55
| Facility | | $69.18 | $112.20 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $416.87
| Facility | 25 | $204.17 | $269.15 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $95.50 / $173.78
| Professional | | $66.07 | $95.50 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $69.18 / $123.03 / $269.15
| Professional | 25 | $69.18 | $123.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $64.57
| Professional | | $32.36 | $33.11 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $125.89 / $331.13
| Facility | | $93.33 | $125.89 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $165.96 / $416.87
| Professional | | $75.86 | $165.96 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $186.21
| Facility | | $69.18 | $112.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $204.17
| Professional | | $79.43 | $112.20 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $93.33 / $138.04
| Facility | | $60.26 | $93.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $162.18
| Professional | | $66.07 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $154.88
| Professional | 25 | $70.79 | $89.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $117.49 / $128.82
| Professional | | $85.11 | $117.49 | $128.82 |