- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $64.57 / $257.04
| Facility | | $28.84 | $64.57 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $64.57 / $147.91 / $426.58
| Facility | 25 | $64.57 | $147.91 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Facility | 50 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $51.29 / $114.82
| Professional | | $28.18 | $51.29 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $125.89
| Professional | 25 | $32.36 | $57.54 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $35.48 / $46.77
| Facility | | $28.84 | $35.48 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $42.66 / $77.62
| Professional | | $20.89 | $42.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Professional | 25 | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $128.82 / $199.53
| Facility | | $39.81 | $128.82 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | 22 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Facility | 62 | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $5.37 / $5.37 / $5.37
| Facility | AS | $5.37 | $5.37 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $50.12 / $100.00
| Professional | | $28.84 | $50.12 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $42.66 / $69.18
| Facility | | $21.38 | $42.66 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $48.98 / $107.15
| Professional | | $25.70 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $100.00
| Professional | 25 | $52.48 | $79.43 | $100.00 |