- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $724.44 / $1,000.00
| Facility | | $309.03 | $724.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $338.84 / $630.96 / $831.76
| Facility | 25 | $338.84 | $630.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $123.03
| Professional | | $30.90 | $52.48 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $52.48 / $93.33 / $234.42
| Professional | 25 | $52.48 | $93.33 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,122.02 / $1,258.93
| Facility | | $537.03 | $1,122.02 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $87.10
| Professional | | $37.15 | $58.88 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $1,023.29
| Facility | | $489.78 | $489.78 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $95.50
| Professional | | $34.67 | $52.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $67.61 / $100.00
| Professional | | $38.02 | $67.61 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $512.86 / $512.86
| Facility | | $501.19 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $75.86
| Professional | | $46.77 | $66.07 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $933.25 / $1,862.09
| Facility | | $741.31 | $933.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $60.26 / $102.33
| Professional | | $38.02 | $60.26 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $85.11
| Professional | 25 | $67.61 | $85.11 | $85.11 |