- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $190.55 / $512.86
| Facility | | $87.10 | $190.55 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $204.17 / $724.44 / $870.96
| Facility | 25 | $204.17 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $109.65 / $245.47
| Professional | | $64.57 | $109.65 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $56.23 / $120.23 / $251.19
| Professional | 25 | $56.23 | $120.23 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $162.18 / $251.19
| Professional | | $95.50 | $162.18 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $104.71 / $177.83 / $257.04
| Professional | 25 | $104.71 | $177.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 50 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $229.09 / $323.59
| Facility | | $147.91 | $229.09 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $165.96 / $239.88
| Professional | | $95.50 | $165.96 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $165.96
| Facility | | $104.71 | $147.91 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $295.12
| Professional | | $77.62 | $141.25 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $213.80
| Facility | | $79.43 | $125.89 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $275.42
| Facility | 25 | $194.98 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $234.42 / $316.23
| Professional | | $134.90 | $234.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $177.83 / $223.87 / $288.40
| Professional | 25 | $177.83 | $223.87 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $190.55 / $251.19
| Professional | | $151.36 | $190.55 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $190.55 / $288.40
| Professional | | $131.83 | $190.55 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $331.13
| Facility | | $275.42 | $275.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $234.42
| Professional | | $104.71 | $134.90 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $177.83
| Facility | | $100.00 | $158.49 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $245.47
| Professional | | $83.18 | $131.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $158.49 / $204.17
| Professional | 25 | $79.43 | $158.49 | $204.17 |