- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $102.33
| Facility | | $61.66 | $79.43 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | 25 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $102.33 / $204.17
| Professional | | $66.07 | $102.33 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $234.42
| Professional | 25 | $67.61 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $154.88
| Professional | | $75.86 | $114.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $87.10 / $112.20 / $151.36
| Professional | 25 | $87.10 | $112.20 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $128.82
| Facility | | $91.20 | $91.20 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $112.20
| Professional | | $100.00 | $100.00 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $125.89 / $141.25
| Facility | | $109.65 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $165.96
| Professional | | $74.13 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $138.04
| Facility | | $48.98 | $67.61 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $141.25
| Professional | | $64.57 | $93.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $72.44 / $131.83 / $213.80
| Professional | 25 | $72.44 | $131.83 | $213.80 |