- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $100.00 / $457.09
| Facility | | $53.70 | $100.00 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $257.04 / $354.81 / $575.44
| Facility | 25 | $257.04 | $354.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $83.18 / $173.78
| Professional | | $51.29 | $83.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $52.48 / $85.11 / $181.97
| Professional | 25 | $52.48 | $85.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $257.04 / $263.03 / $269.15
| Professional | 50 | $257.04 | $263.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $141.25
| Professional | | $56.23 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $151.36
| Professional | 25 | $70.79 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | 50 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $131.83
| Professional | | $50.12 | $74.13 | $131.83 |
- 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
- $66.07 / $89.13 / $125.89
| Facility | | $66.07 | $89.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $138.04
| Professional | | $83.18 | $107.15 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $141.25 / $229.09
| Facility | | $114.82 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $141.25
| Professional | | $51.29 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $169.82
| Professional | | $58.88 | $97.72 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $169.82 / $213.80 / $302.00
| Professional | 22 | $169.82 | $213.80 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 62
- Typical Low / Median / Typical High
- $52.48 / $67.61 / $93.33
| Professional | 62 | $52.48 | $67.61 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $4.47 / $5.75 / $7.94
| Professional | 80 | $4.47 | $5.75 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $2.24 / $2.88 / $3.98
| Professional | AS | $2.24 | $2.88 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $489.78
| Facility | | $87.10 | $151.36 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $177.83
| Professional | | $66.07 | $107.15 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $60.26 / $112.20
| Facility | | $48.98 | $60.26 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $74.13 / $125.89
| Professional | | $46.77 | $74.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $138.04
| Professional | 25 | $75.86 | $89.13 | $138.04 |