- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $426.58 / $588.84
| Facility | | $95.50 | $426.58 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $489.78
| Facility | 25 | $263.03 | $371.54 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $25.70 / $66.07
| Professional | | $7.94 | $25.70 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $21.88 / $70.79 / $70.79
| Professional | 25 | $21.88 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $25.70 / $51.29
| Professional | | $15.85 | $25.70 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $22.91 / $30.90
| Professional | | $17.78 | $22.91 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $40.74 / $338.84
| Facility | | $14.79 | $40.74 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $173.78 / $371.54 / $489.78
| Facility | 25 | $173.78 | $371.54 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $22.91 / $42.66
| Facility | | $18.62 | $22.91 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $35.48 / $81.28
| Facility | | $14.79 | $35.48 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $371.54
| Facility | | $309.03 | $309.03 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,000.00 / $1,258.93
| Facility | | $489.78 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $41.69 / $69.18
| Professional | | $22.91 | $41.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 25 | $85.11 | $85.11 | $85.11 |