- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $389.05 / $562.34
| Facility | | $295.12 | $389.05 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $346.74 / $436.52 / $524.81
| Facility | 25 | $346.74 | $436.52 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $52.48 / $93.33
| Professional | | $30.20 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $309.03
| Professional | 25 | $60.26 | $91.20 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $467.74 / $524.81
| Facility | | $446.68 | $467.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $109.65 / $134.90
| Professional | | $66.07 | $109.65 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $295.12 / $354.81
| Facility | | $151.36 | $295.12 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $112.20 / $169.82
| Professional | | $60.26 | $112.20 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $281.84
| Facility | | $114.82 | $165.96 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $151.36
| Professional | | $67.61 | $100.00 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $69.18 / $257.04
| Facility | | $37.15 | $69.18 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $144.54 / $323.59 / $354.81
| Facility | 25 | $144.54 | $323.59 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $95.50 / $501.19
| Professional | | $44.67 | $95.50 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $616.60 / $2,290.87
| Facility | | $467.74 | $616.60 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $95.50 / $151.36
| Professional | | $44.67 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | 25 | $67.61 | $67.61 | $67.61 |