- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $346.74 / $630.96
| Facility | | $158.49 | $346.74 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $549.54
| Facility | 25 | $245.47 | $346.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $107.15
| Professional | | $32.36 | $52.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $43.65 / $75.86 / $194.98
| Professional | 25 | $43.65 | $75.86 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $50.12 / $147.91
| Professional | | $38.90 | $50.12 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $42.66 / $46.77
| Professional | | $34.67 | $42.66 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $512.86 / $851.14
| Facility | | $275.42 | $512.86 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $114.82
| Professional | | $34.67 | $53.70 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $1,698.24
| Facility | | $575.44 | $575.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $50.12
| Professional | | $21.88 | $32.36 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $74.13
| Professional | | $32.36 | $36.31 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $91.20
| Professional | | $30.90 | $43.65 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $87.10
| Professional | 25 | $57.54 | $85.11 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $43.65
| Professional | | $31.62 | $31.62 | $43.65 |