- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $57.54 / $144.54
| Facility | | $24.55 | $57.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $93.33 / $446.68 / $588.84
| Facility | 25 | $93.33 | $446.68 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $53.70 / $128.82
| Professional | | $28.18 | $53.70 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $32.36 / $60.26 / $147.91
| Professional | 25 | $32.36 | $60.26 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $117.49 / $223.87
| Facility | | $26.92 | $117.49 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | 62 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Facility | AS | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $57.54 / $181.97
| Professional | | $27.54 | $57.54 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.50 / $33.88 / $70.79
| Professional | 25 | $19.50 | $33.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $63.10 / $91.20
| Facility | | $39.81 | $63.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $69.18 / $123.03
| Professional | | $39.81 | $69.18 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $263.03
| Facility | | $151.36 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $104.71
| Professional | | $30.90 | $52.48 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $27.54 / $51.29
| Facility | | $15.85 | $27.54 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $52.48 / $95.50
| Professional | | $27.54 | $52.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $72.44 / $144.54
| Professional | | $37.15 | $72.44 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $64.57 / $83.18
| Facility | | $63.10 | $64.57 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $165.96
| Professional | | $51.29 | $81.28 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $117.49 / $223.87
| Facility | | $26.92 | $117.49 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | 62 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Facility | AS | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $57.54 / $181.97
| Professional | | $27.54 | $57.54 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.50 / $33.88 / $70.79
| Professional | 25 | $19.50 | $33.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $26.92 / $83.18
| Facility | | $18.62 | $26.92 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $43.65 / $102.33
| Professional | | $22.91 | $43.65 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $66.07
| Facility | | $33.88 | $48.98 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $58.88 / $138.04
| Professional | | $27.54 | $58.88 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $100.00
| Professional | 25 | $67.61 | $85.11 | $100.00 |