- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $81.28 / $257.04
| Facility | | $33.11 | $81.28 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $208.93 / $575.44 / $575.44
| Facility | 25 | $208.93 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $45.71 / $91.20
| Professional | | $27.54 | $45.71 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $31.62 / $53.70 / $102.33
| Professional | 25 | $31.62 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $53.70 / $75.86
| Professional | | $29.51 | $53.70 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $40.74 / $56.23 / $77.62
| Professional | 25 | $40.74 | $56.23 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $128.82
| Facility | | $45.71 | $45.71 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $56.23
| Professional | | $50.12 | $50.12 | $56.23 |
- 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
- $26.30 / $42.66 / $77.62
| Professional | | $26.30 | $42.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $27.54 / $69.18
| Facility | | $16.22 | $27.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $38.02 / $60.26
| Professional | | $22.39 | $38.02 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $79.43 / $89.13
| Professional | 25 | $67.61 | $79.43 | $89.13 |