- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $213.80 / $389.05
| Facility | | $104.71 | $213.80 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $371.54
| Professional | | $112.20 | $158.49 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Professional | 25 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $128.82
| Professional | 52 | $123.03 | $123.03 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $134.90 / $371.54
| Facility | | $131.83 | $134.90 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $346.74 / $537.03
| Professional | | $190.55 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $97.72
| Professional | 52 | $85.11 | $85.11 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $1,288.25
| Facility | | $407.38 | $537.03 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $436.52
| Professional | | $162.18 | $223.87 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $524.81 / $1,047.13
| Facility | | $407.38 | $524.81 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $208.93 / $407.38
| Professional | | $177.83 | $208.93 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $309.03
| Facility | | $144.54 | $213.80 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $234.42 / $501.19
| Professional | | $144.54 | $234.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $181.97
| Professional | 52 | $169.82 | $169.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $446.68
| Professional | | $120.23 | $199.53 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $138.04
| Professional | 52 | $100.00 | $138.04 | $138.04 |