- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $537.03
| Facility | | $177.83 | $234.42 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 25 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $30.20 / $66.07
| Professional | | $7.94 | $30.20 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.96 / $39.81 / $234.42
| Professional | 25 | $10.96 | $39.81 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $144.54 / $147.91
| Facility | | $125.89 | $144.54 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $489.78 / $489.78
| Facility | | $323.59 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $22.39 / $46.77
| Professional | | $13.49 | $22.39 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $10.47 / $20.89
| Facility | | $5.50 | $10.47 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $24.55
| Facility | 25 | $12.02 | $12.02 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $151.36
| Facility | | $114.82 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $15.85 / $489.78
| Facility | | $8.51 | $15.85 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $199.53 / $1,000.00
| Facility | | $123.03 | $199.53 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $25.70 / $50.12
| Professional | | $14.45 | $25.70 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $27.54 / $85.11 / $85.11
| Professional | 25 | $27.54 | $85.11 | $85.11 |