- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $95.50 / $239.88
| Facility | | $53.70 | $95.50 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $63.10 / $213.80 / $776.25
| Facility | 25 | $63.10 | $213.80 | $776.25 |
- 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 / $87.10 / $199.53
| Professional | 25 | $52.48 | $87.10 | $199.53 |
- 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
- $53.70 / $81.28 / $109.65
| Professional | | $53.70 | $81.28 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $109.65
| Professional | 25 | $70.79 | $85.11 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Professional | 50 | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $104.71
| Professional | | $50.12 | $70.79 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $114.82
| Professional | | $57.54 | $85.11 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $199.53
| Facility | | $102.33 | $147.91 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $138.04
| Professional | | $51.29 | $79.43 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $147.91
| Facility | | $47.86 | $77.62 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $69.18 / $234.42 / $407.38
| Facility | 25 | $69.18 | $234.42 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | 62 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Facility | AS | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $562.34
| Professional | | $64.57 | $102.33 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $74.13 / $97.72 / $138.04
| Professional | 25 | $74.13 | $97.72 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $100.00 / $131.83
| Professional | | $72.44 | $100.00 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $117.49
| Professional | 25 | $72.44 | $93.33 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $74.13 / $112.20
| Facility | | $33.11 | $74.13 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $72.44 / $123.03
| Professional | | $45.71 | $72.44 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $138.04
| Professional | 25 | $70.79 | $89.13 | $138.04 |