- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $512.86 / $645.65
| Facility | | $199.53 | $512.86 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $323.59 / $524.81 / $645.65
| Facility | 25 | $323.59 | $524.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $263.03
| Professional | | $28.84 | $51.29 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $40.74 / $85.11 / $281.84
| Professional | 25 | $40.74 | $85.11 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $48.98 / $95.50
| Professional | | $38.02 | $48.98 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $676.08 / $676.08
| Facility | | $549.54 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $64.57 / $91.20
| Professional | | $30.90 | $64.57 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $60.26
| Facility | | $38.90 | $47.86 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $63.10
| Professional | | $39.81 | $46.77 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $93.33
| Professional | | $30.20 | $45.71 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $851.14 / $1,202.26
| Facility | | $398.11 | $851.14 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $44.67 / $87.10
| Professional | | $34.67 | $44.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $87.10
| Professional | 25 | $67.61 | $85.11 | $87.10 |