- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $199.53 / $275.42
| Facility | | $69.18 | $199.53 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $223.87 / $234.42 / $234.42
| Facility | 25 | $223.87 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $223.87
| Professional | | $64.57 | $104.71 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $281.84
| Professional | 25 | $79.43 | $128.82 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $125.89 / $302.00
| Professional | | $83.18 | $125.89 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $123.03 / $218.78
| Facility | | $70.79 | $123.03 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $223.87 / $234.42 / $269.15
| Facility | 25 | $223.87 | $234.42 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $162.18 / $354.81
| Professional | | $79.43 | $162.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $75.86 / $138.04 / $316.23
| Professional | 25 | $75.86 | $138.04 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $3,467.37
| Facility | | $199.53 | $199.53 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $257.04 / $302.00
| Professional | | $173.78 | $257.04 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $120.23 / $218.78
| Facility | | $72.44 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $158.49 / $295.12
| Professional | | $79.43 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $134.90 / $309.03
| Professional | | $70.79 | $134.90 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $75.86 / $134.90 / $204.17
| Professional | 25 | $75.86 | $134.90 | $204.17 |