- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $309.03 / $398.11
| Facility | | $245.47 | $309.03 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $575.44
| Facility | 25 | $389.05 | $389.05 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $53.70 / $125.89
| Professional | | $30.90 | $53.70 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $53.70 / $89.13 / $281.84
| Professional | 25 | $53.70 | $89.13 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $66.07 / $501.19
| Professional | | $37.15 | $66.07 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $263.03 / $275.42
| Facility | | $229.09 | $263.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $79.43 / $107.15
| Professional | | $46.77 | $79.43 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $489.78 / $489.78
| Facility | | $323.59 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $54.95 / $117.49
| Professional | | $30.20 | $54.95 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $37.15 / $67.61
| Facility | | $20.42 | $37.15 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $47.86
| Facility | 25 | $44.67 | $44.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $41.69 / $66.07
| Professional | | $21.38 | $41.69 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $81.28 / $114.82
| Professional | | $42.66 | $81.28 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $275.42
| Facility | | $125.89 | $190.55 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $74.13
| Professional | | $46.77 | $66.07 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $66.07 / $501.19
| Professional | | $37.15 | $66.07 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $32.36 / $489.78
| Facility | | $29.51 | $32.36 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $123.03
| Professional | | $30.20 | $44.67 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $398.11 / $1,288.25
| Facility | | $229.09 | $398.11 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $69.18 / $125.89
| Professional | | $39.81 | $69.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $44.67 / $85.11 / $95.50
| Professional | 25 | $44.67 | $85.11 | $95.50 |