- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $562.34 / $691.83
| Facility | | $398.11 | $562.34 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $407.38 / $588.84 / $933.25
| Facility | 25 | $407.38 | $588.84 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $56.23 / $104.71
| Professional | | $30.90 | $56.23 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $50.12 / $93.33 / $208.93
| Professional | 25 | $50.12 | $93.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $58.88 / $79.43
| Professional | | $38.02 | $58.88 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $186.21
| Facility | | $158.49 | $158.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $63.10 / $85.11
| Professional | | $37.15 | $63.10 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $104.71
| Professional | | $39.81 | $79.43 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $60.26 / $89.13
| Facility | | $36.31 | $60.26 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $239.88 / $416.87 / $549.54
| Facility | 25 | $239.88 | $416.87 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $501.19
| Professional | | $50.12 | $72.44 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $104.71
| Professional | | $60.26 | $79.43 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $91.20 / $100.00
| Professional | | $79.43 | $91.20 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $851.14
| Facility | | $724.44 | $724.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $77.62 / $102.33
| Professional | | $64.57 | $77.62 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $102.33
| Professional | | $48.98 | $70.79 | $102.33 |