- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $70.79 / $158.49
| Facility | | $42.66 | $70.79 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | 25 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $63.10 / $117.49
| Professional | | $38.90 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $46.77 / $79.43 / $165.96
| Professional | 25 | $46.77 | $79.43 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $93.33
| Professional | | $46.77 | $70.79 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $56.23 / $69.18 / $79.43
| Professional | 25 | $56.23 | $69.18 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $66.07 / $95.50
| Professional | | $47.86 | $66.07 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $144.54
| Facility | | $100.00 | $120.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $107.15
| Professional | | $46.77 | $70.79 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $70.79 / $114.82
| Facility | | $38.90 | $70.79 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $85.11 / $457.09
| Professional | | $61.66 | $85.11 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $95.50
| Professional | 25 | $50.12 | $72.44 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $109.65
| Facility | | $48.98 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $93.33
| Professional | | $43.65 | $64.57 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $79.43 / $85.11
| Professional | 25 | $70.79 | $79.43 | $85.11 |