- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $389.05 / $645.65
| Facility | | $79.43 | $389.05 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $616.60
| Facility | 25 | $251.19 | $331.13 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $28.18 / $66.07
| Professional | | $7.94 | $28.18 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $21.88 / $48.98 / $70.79
| Professional | 25 | $21.88 | $48.98 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,659.59
| Facility | | $1,548.82 | $1,548.82 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $380.19
| Facility | | $371.54 | $371.54 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $22.39 / $44.67
| Professional | | $11.22 | $22.39 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $229.09 / $363.08
| Facility | | $223.87 | $229.09 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $213.80 / $229.09 / $446.68
| Facility | 25 | $213.80 | $229.09 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,659.59
| Facility | | $1,548.82 | $1,548.82 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $50.12 / $371.54
| Facility | | $16.98 | $50.12 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | 25 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $208.93
| Facility | | $158.49 | $158.49 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $426.58 / $912.01
| Facility | | $269.15 | $426.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $23.99 / $48.98
| Professional | | $13.18 | $23.99 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 25 | $85.11 | $85.11 | $85.11 |