- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $95.50 / $114.82
| Facility | | $57.54 | $95.50 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $117.49 / $239.88
| Professional | | $60.26 | $117.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $263.03
| Professional | 25 | $69.18 | $125.89 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $158.49
| Professional | | $109.65 | $109.65 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $158.49
| Professional | 25 | $147.91 | $147.91 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $89.13 / $144.54
| Professional | | $67.61 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $162.18
| Professional | | $64.57 | $125.89 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $109.65 / $218.78
| Professional | | $63.10 | $109.65 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $107.15 / $208.93
| Facility | | $57.54 | $107.15 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $141.25 / $794.33
| Professional | | $95.50 | $141.25 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $131.83 / $151.36 / $251.19
| Professional | 25 | $131.83 | $151.36 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $162.18
| Professional | | $54.95 | $91.20 | $162.18 |