- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $128.82 / $512.86
| Facility | | $58.88 | $128.82 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $223.87 / $602.56
| Facility | 25 | $70.79 | $223.87 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $81.28 / $169.82
| Professional | | $52.48 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $52.48 / $85.11 / $169.82
| Professional | 25 | $52.48 | $85.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $169.82
| Professional | | $61.66 | $102.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $186.21
| Professional | 25 | $75.86 | $117.49 | $186.21 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $229.09
| Facility | | $109.65 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $169.82
| Professional | | $66.07 | $112.20 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $117.49 / $147.91
| Facility | | $67.61 | $117.49 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $208.93
| Professional | | $52.48 | $95.50 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $83.18 / $151.36
| Facility | | $53.70 | $83.18 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $194.98 / $199.53 / $229.09
| Facility | 25 | $194.98 | $199.53 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $151.36 / $186.21 / $186.21
| Facility | 62 | $151.36 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $23.99 / $29.51 / $29.51
| Facility | AS | $23.99 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $162.18 / $213.80
| Professional | | $93.33 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $114.82 / $154.88 / $194.98
| Professional | 25 | $114.82 | $154.88 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $177.83
| Professional | | $97.72 | $134.90 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $204.17
| Professional | | $87.10 | $128.82 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $275.42
| Facility | | $234.42 | $234.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $97.72 / $162.18
| Professional | | $72.44 | $97.72 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $177.83
| Facility | | $72.44 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $91.20 / $162.18
| Professional | | $58.88 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $41.69 / $97.72 / $120.23
| Professional | 25 | $41.69 | $97.72 | $120.23 |