- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $93.33 / $194.98
| Facility | | $48.98 | $93.33 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $676.08
| Facility | 25 | $120.23 | $199.53 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $87.10 / $208.93
| Professional | | $48.98 | $87.10 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $51.29 / $91.20 / $229.09
| Professional | 25 | $51.29 | $91.20 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $257.04 / $269.15 / $269.15
| Professional | 50 | $257.04 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $218.78 / $630.96
| Facility | | $48.98 | $218.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Facility | 62 | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Facility | AS | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $97.72 / $269.15
| Professional | | $51.29 | $97.72 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $114.82
| Professional | 25 | $35.48 | $56.23 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $109.65 / $173.78
| Facility | | $75.86 | $109.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $128.82 / $199.53
| Professional | | $75.86 | $128.82 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $263.03
| Facility | | $151.36 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $173.78
| Professional | | $52.48 | $89.13 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $91.20
| Facility | | $28.84 | $48.98 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $83.18 / $154.88
| Professional | | $45.71 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $229.09
| Professional | | $69.18 | $125.89 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $102.33 / $295.12
| Facility | | $97.72 | $102.33 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $295.12
| Professional | | $97.72 | $134.90 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $218.78 / $630.96
| Facility | | $48.98 | $218.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Facility | 62 | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Facility | AS | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $97.72 / $269.15
| Professional | | $51.29 | $97.72 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $114.82
| Professional | 25 | $35.48 | $56.23 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $125.89
| Facility | | $36.31 | $36.31 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $69.18 / $154.88
| Professional | | $38.02 | $69.18 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $95.50 / $112.20
| Facility | | $47.86 | $95.50 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $95.50 / $213.80
| Professional | | $47.86 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $128.82
| Professional | 25 | $79.43 | $89.13 | $128.82 |