- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $154.88 / $302.00
| Facility | | $102.33 | $154.88 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $114.82 / $269.15 / $741.31
| Facility | 25 | $114.82 | $269.15 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $169.82 / $416.87
| Professional | | $93.33 | $169.82 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $107.15 / $208.93 / $467.74
| Professional | 25 | $107.15 | $208.93 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $223.87
| Professional | | $112.20 | $162.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $141.25 / $169.82 / $204.17
| Professional | 25 | $141.25 | $169.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $144.54 / $208.93
| Professional | | $109.65 | $144.54 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $234.42
| Professional | | $125.89 | $177.83 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $223.87
| Facility | | $120.23 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $275.42
| Professional | | $114.82 | $162.18 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $288.40
| Facility | | $104.71 | $158.49 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $707.95
| Facility | 25 | $630.96 | $630.96 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $1,122.02
| Professional | | $123.03 | $194.98 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $302.00
| Professional | 25 | $154.88 | $213.80 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $199.53 / $269.15
| Professional | | $158.49 | $199.53 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $162.18 / $181.97 / $234.42
| Professional | 25 | $162.18 | $181.97 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $223.87
| Facility | | $70.79 | $120.23 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $141.25 / $239.88
| Professional | | $91.20 | $141.25 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $407.38
| Professional | 25 | $70.79 | $95.50 | $407.38 |