- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $302.00 / $741.31
| Facility | | $87.10 | $302.00 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $380.19 / $630.96 / $3,311.31
| Facility | 25 | $380.19 | $630.96 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $114.82 / $257.04
| Professional | | $66.07 | $114.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $125.89 / $281.84
| Professional | 25 | $61.66 | $125.89 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | 50 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $346.74
| Professional | | $79.43 | $128.82 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $134.90 / $295.12
| Facility | | $75.86 | $134.90 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $77.62 / $426.58 / $977.24
| Facility | 25 | $77.62 | $426.58 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $181.97 / $407.38
| Professional | | $79.43 | $181.97 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $60.26 / $131.83 / $316.23
| Professional | 25 | $60.26 | $131.83 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $3,467.37
| Facility | | $234.42 | $234.42 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $316.23
| Professional | | $190.55 | $263.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $128.82 / $239.88
| Facility | | $77.62 | $128.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $181.97 / $338.84
| Professional | | $79.43 | $181.97 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $147.91 / $323.59
| Professional | | $79.43 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $234.42
| Professional | 25 | $89.13 | $89.13 | $234.42 |