- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $93.33 / $316.23
| Facility | | $48.98 | $93.33 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $213.80 / $549.54
| Facility | 25 | $67.61 | $213.80 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | 50 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $85.11 / $190.55
| Professional | | $51.29 | $85.11 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $204.17
| Professional | 25 | $52.48 | $89.13 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $64.57 / $263.03 / $269.15
| Professional | 50 | $64.57 | $263.03 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $75.86
| Facility | | $54.95 | $69.18 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $72.44 / $128.82
| Professional | | $34.67 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | 25 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $239.88
| Facility | | $102.33 | $141.25 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Facility | 22 | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Facility | 62 | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.23
| Facility | AS | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $83.18 / $169.82
| Professional | | $51.29 | $83.18 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $112.20
| Facility | | $38.90 | $61.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $77.62 / $169.82
| Professional | | $45.71 | $77.62 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $138.04
| Professional | 25 | $70.79 | $89.13 | $138.04 |