- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $275.42 / $457.09
| Facility | | $123.03 | $275.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $478.63
| Professional | | $125.89 | $173.78 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | 25 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $371.54
| Professional | | $134.90 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $389.05
| Professional | | $177.83 | $234.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $186.21 / $446.68
| Professional | | $93.33 | $186.21 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $141.25 / $239.88
| Facility | | $109.65 | $141.25 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $144.54 / $223.87
| Professional | | $112.20 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $131.83
| Professional | | $32.36 | $33.11 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $316.23 / $380.19
| Facility | | $199.53 | $316.23 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $478.63
| Professional | | $199.53 | $269.15 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $234.42 / $389.05
| Professional | | $186.21 | $234.42 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $707.95
| Facility | | $75.86 | $89.13 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $204.17 / $398.11
| Professional | | $125.89 | $204.17 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $218.78 / $323.59
| Professional | | $169.82 | $218.78 | $323.59 |