- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $501.19 / $616.60
| Facility | | $60.26 | $501.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $416.87 / $537.03 / $602.56
| Facility | 25 | $416.87 | $537.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $102.33
| Professional | | $30.90 | $50.12 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $128.82 / $275.42
| Professional | 25 | $66.07 | $128.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $181.97 / $295.12
| Facility | | $169.82 | $181.97 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $85.11
| Professional | | $61.66 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $93.33
| Professional | | $35.48 | $54.95 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $128.82
| Facility | | $38.90 | $61.66 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $281.84 / $537.03 / $602.56
| Facility | 25 | $281.84 | $537.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $61.66 / $93.33
| Professional | | $34.67 | $61.66 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $61.66 / $83.18
| Professional | | $52.48 | $61.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $67.61 / $93.33
| Professional | | $38.02 | $67.61 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $87.10
| Professional | | $40.74 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $85.11
| Professional | 25 | $67.61 | $67.61 | $85.11 |