- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $173.78
| Facility | | $51.29 | $74.13 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $47.86 / $158.49 / $537.03
| Facility | 25 | $47.86 | $158.49 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $87.10 / $190.55
| Professional | | $51.29 | $87.10 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $199.53
| Professional | 25 | $52.48 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $123.03 / $263.03 / $263.03
| Professional | 50 | $123.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $117.49
| Professional | | $51.29 | $77.62 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $131.83
| Professional | 25 | $63.10 | $87.10 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $97.72
| Facility | | $79.43 | $93.33 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $114.82
| Professional | | $72.44 | $93.33 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $112.20
| Facility | | $63.10 | $83.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $199.53
| Professional | | $83.18 | $112.20 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $147.91
| Facility | | $134.90 | $134.90 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $165.96
| Professional | | $50.12 | $74.13 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $117.49
| Facility | | $51.29 | $74.13 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $165.96 / $426.58
| Facility | 25 | $66.07 | $165.96 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $169.82
| Professional | | $51.29 | $79.43 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $199.53
| Professional | 25 | $52.48 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $263.03
| Professional | 50 | $123.03 | $123.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $147.91
| Facility | | $134.90 | $134.90 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $112.20
| Professional | | $50.12 | $70.79 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $112.20
| Facility | | $44.67 | $54.95 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $75.86 / $151.36
| Professional | | $46.77 | $75.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $144.54
| Professional | 25 | $70.79 | $91.20 | $144.54 |