- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $724.44 / $758.58
| Facility | | $281.84 | $724.44 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $588.84
| Facility | 25 | $295.12 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $141.25
| Professional | | $28.84 | $43.65 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $45.71 / $91.20 / $177.83
| Professional | 25 | $45.71 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $53.70
| Professional | | $32.36 | $39.81 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $263.03 / $263.03
| Facility | | $251.19 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $56.23
| Professional | | $47.86 | $56.23 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $87.10
| Professional | | $36.31 | $52.48 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $112.20
| Facility | | $36.31 | $51.29 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $53.70 / $501.19
| Professional | | $38.02 | $53.70 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $776.25
| Facility | | $691.83 | $691.83 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $79.43
| Professional | | $33.88 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $85.11
| Professional | 25 | $67.61 | $85.11 | $85.11 |