- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $537.03 / $676.08
| Facility | | $79.43 | $537.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $120.23 / $323.59 / $660.69
| Facility | 25 | $120.23 | $323.59 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $51.29 / $89.13
| Professional | | $30.20 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $162.18
| Professional | 25 | $45.71 | $75.86 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $104.71
| Professional | | $39.81 | $54.95 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $1,445.44
| Facility | | $288.40 | $288.40 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $38.90 / $51.29
| Professional | | $34.67 | $38.90 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $117.49
| Facility | | $39.81 | $54.95 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $41.69 / $97.72
| Professional | | $38.02 | $41.69 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $46.77 / $69.18
| Professional | | $34.67 | $46.77 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $53.70 / $70.79
| Professional | | $45.71 | $53.70 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $1,122.02 / $1,698.24
| Facility | | $186.21 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $42.66 / $64.57
| Professional | | $33.11 | $42.66 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $87.10
| Professional | 25 | $44.67 | $67.61 | $87.10 |