- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $123.03 / $316.23
| Facility | | $36.31 | $123.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $114.82 / $213.80 / $213.80
| Facility | 25 | $114.82 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $83.18
| Professional | | $27.54 | $44.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $27.54 / $51.29 / $97.72
| Professional | 25 | $27.54 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $52.48 / $72.44
| Professional | | $30.20 | $52.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $37.15 / $54.95 / $69.18
| Professional | 25 | $37.15 | $54.95 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | 50 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $72.44
| Professional | | $34.67 | $47.86 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $144.54
| Facility | | $100.00 | $120.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $43.65 / $69.18
| Professional | | $27.54 | $43.65 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $81.28
| Facility | | $26.92 | $45.71 | $81.28 |
- 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
- $38.02 / $53.70 / $354.81
| Professional | | $38.02 | $53.70 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $66.07
| Professional | 25 | $42.66 | $52.48 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $85.11
| Facility | | $25.12 | $38.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $63.10
| Professional | | $22.91 | $38.02 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $37.15 / $70.79 / $89.13
| Professional | 25 | $37.15 | $70.79 | $89.13 |