- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $263.03 / $371.54
| Facility | | $169.82 | $263.03 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $295.12
| Facility | 25 | $169.82 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $21.88 / $66.07
| Professional | | $7.08 | $21.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.96 / $21.88 / $48.98
| Professional | 25 | $10.96 | $21.88 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $263.03 / $467.74
| Facility | | $245.47 | $263.03 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $79.43 / $95.50
| Facility | | $40.74 | $79.43 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $30.20 / $45.71
| Professional | | $17.78 | $30.20 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $44.67 / $75.86
| Facility | | $30.90 | $44.67 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $22.39 / $77.62
| Facility | | $10.23 | $22.39 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $389.05 / $2,398.83
| Facility | | $363.08 | $389.05 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $36.31 / $70.79
| Professional | | $17.78 | $36.31 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 25 | $85.11 | $85.11 | $85.11 |