- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $74.13 / $316.23
| Facility | | $28.84 | $74.13 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $50.12 / $162.18 / $323.59
| Facility | 25 | $50.12 | $162.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $47.86 / $100.00
| Professional | | $28.18 | $47.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $29.51 / $56.23 / $117.49
| Professional | 25 | $29.51 | $56.23 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $70.79
| Professional | | $28.84 | $51.29 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $66.07
| Professional | 25 | $36.31 | $54.95 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $27.54 / $46.77
| Facility | | $26.30 | $27.54 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $48.98
| Professional | | $21.38 | $33.11 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $56.23 / $100.00
| Professional | | $33.88 | $56.23 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $57.54
| Facility | | $30.90 | $42.66 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $234.42
| Facility | | $89.13 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $46.77 / $81.28
| Professional | | $28.84 | $46.77 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $223.87 / $223.87
| Facility | | $44.67 | $223.87 | $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
- $40.74 / $66.07 / $354.81
| Professional | | $40.74 | $66.07 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $87.10
| Facility | | $28.18 | $46.77 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $50.12 / $165.96 / $323.59
| Facility | 25 | $50.12 | $165.96 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $77.62
| Professional | | $28.18 | $43.65 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $28.84 / $54.95 / $117.49
| Professional | 25 | $28.84 | $54.95 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $25.70 / $33.11
| Professional | | $13.49 | $25.70 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $79.43 / $186.21
| Facility | | $77.62 | $79.43 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $72.44 / $213.80
| Professional | | $33.88 | $72.44 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $47.86 / $87.10
| Facility | | $28.18 | $47.86 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | 22 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Facility | 62 | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $5.01
| Facility | AS | $5.01 | $5.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $47.86 / $89.13
| Professional | | $29.51 | $47.86 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $41.69 / $85.11
| Facility | | $19.95 | $41.69 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $39.81 / $69.18
| Professional | | $23.44 | $39.81 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $89.13
| Professional | 25 | $60.26 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $58.88 / $64.57
| Professional | | $28.18 | $58.88 | $64.57 |