- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $302.00 / $389.05
| Facility | | $44.67 | $302.00 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $208.93 / $331.13 / $616.60
| Facility | 25 | $208.93 | $331.13 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $144.54
| Professional | | $30.90 | $52.48 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $57.54 / $93.33 / $269.15
| Professional | 25 | $57.54 | $93.33 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $45.71 / $70.79
| Professional | | $39.81 | $45.71 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $70.79 / $213.80
| Facility | | $61.66 | $70.79 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $66.07 / $70.79
| Professional | | $58.88 | $66.07 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $89.13
| Facility | | $39.81 | $58.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $97.72
| Professional | | $38.90 | $48.98 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $141.25
| Professional | | $32.36 | $47.86 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $245.47 / $407.38
| Facility | | $37.15 | $245.47 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $204.17 / $331.13 / $512.86
| Facility | 25 | $204.17 | $331.13 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $107.15
| Professional | | $33.11 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $89.13
| Professional | | $31.62 | $45.71 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $51.29 / $120.23
| Professional | | $37.15 | $51.29 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $93.33
| Professional | 25 | $57.54 | $87.10 | $93.33 |