- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $199.53 / $512.86
| Facility | | $42.66 | $199.53 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $177.83 / $478.63 / $933.25
| Facility | 25 | $177.83 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $52.48 / $204.17
| Professional | | $28.84 | $52.48 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $48.98 / $77.62 / $251.19
| Professional | 25 | $48.98 | $77.62 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $45.71 / $56.23
| Professional | | $38.02 | $45.71 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $831.76
| Facility | | $251.19 | $251.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $35.48 / $77.62
| Professional | | $26.30 | $35.48 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $67.61
| Facility | | $38.90 | $48.98 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $46.77 / $63.10
| Professional | | $38.90 | $46.77 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $54.95 / $194.98
| Professional | | $34.67 | $54.95 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $33.11
| Professional | | $19.05 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $354.81
| Facility | | $245.47 | $245.47 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $85.11
| Professional | | $33.11 | $43.65 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $44.67 / $85.11 / $87.10
| Professional | 25 | $44.67 | $85.11 | $87.10 |