- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $83.18 / $281.84
| Facility | | $40.74 | $83.18 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $72.44 / $117.49 / $204.17
| Facility | 25 | $72.44 | $117.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $50.12 / $97.72
| Professional | | $27.54 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $34.67 / $58.88 / $104.71
| Professional | 25 | $34.67 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $66.07 / $107.15
| Professional | | $43.65 | $66.07 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $114.82
| Professional | 25 | $46.77 | $66.07 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $177.83
| Facility | | $79.43 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $64.57 / $104.71
| Professional | | $34.67 | $64.57 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $74.13 / $147.91
| Facility | | $47.86 | $74.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $56.23 / $131.83
| Professional | | $30.20 | $56.23 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $51.29 / $93.33
| Facility | | $29.51 | $51.29 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $162.18
| Facility | 25 | $77.62 | $77.62 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $93.33 / $100.00 / $100.00
| Facility | 62 | $93.33 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $15.14 / $15.85 / $15.85
| Facility | AS | $15.14 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $97.72 / $223.87
| Professional | | $50.12 | $97.72 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $69.18 / $95.50 / $120.23
| Professional | 25 | $69.18 | $95.50 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $81.28 / $109.65
| Professional | | $47.86 | $81.28 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $75.86 / $125.89
| Professional | | $43.65 | $75.86 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $162.18
| Facility | | $138.04 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $53.70 / $102.33
| Professional | | $45.71 | $53.70 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $69.18 / $177.83
| Facility | | $57.54 | $69.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $53.70 / $102.33
| Professional | | $30.20 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | 25 | $89.13 | $89.13 | $89.13 |