- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $208.93 / $1,288.25
| Facility | | $52.48 | $208.93 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $239.88 / $1,000.00 / $1,288.25
| Facility | 25 | $239.88 | $1,000.00 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $114.82 / $323.59
| Professional | | $64.57 | $114.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $128.82 / $331.13
| Professional | 25 | $70.79 | $128.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $147.91
| Professional | | $74.13 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $87.10 / $109.65 / $144.54
| Professional | 25 | $87.10 | $109.65 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $43.65 / $79.43
| Facility | | $21.88 | $43.65 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $120.23
| Professional | | $61.66 | $83.18 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $234.42
| Facility | | $95.50 | $120.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $204.17
| Professional | | $72.44 | $107.15 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $158.49
| Facility | | $66.07 | $97.72 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 25 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $691.83
| Professional | | $89.13 | $134.90 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $91.20 / $162.18 / $269.15
| Professional | 25 | $91.20 | $162.18 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $100.00
| Facility | | $52.48 | $69.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $100.00 / $173.78
| Professional | | $66.07 | $100.00 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $75.86 / $128.82 / $181.97
| Professional | 25 | $75.86 | $128.82 | $181.97 |