- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $512.86 / $954.99
| Facility | | $162.18 | $512.86 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $165.96 / $549.54 / $977.24
| Facility | 25 | $165.96 | $549.54 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $53.70 / $281.84
| Professional | | $30.90 | $53.70 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $57.54 / $104.71 / $288.40
| Professional | 25 | $57.54 | $104.71 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $107.15
| Professional | | $39.81 | $47.86 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $537.03 / $676.08
| Facility | | $213.80 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $60.26
| Professional | | $42.66 | $53.70 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $52.48
| Facility | | $39.81 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $323.59
| Facility | | $302.00 | $302.00 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $107.15
| Professional | | $33.88 | $46.77 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $645.65 / $933.25
| Facility | | $251.19 | $645.65 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $67.61
| Professional | | $30.90 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $87.10
| Professional | 25 | $67.61 | $67.61 | $87.10 |