- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $416.87 / $676.08
| Facility | | $123.03 | $416.87 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $426.58 / $630.96 / $741.31
| Facility | 25 | $426.58 | $630.96 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $95.50
| Professional | | $33.88 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $354.81
| Professional | 25 | $67.61 | $114.82 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $46.77 / $120.23
| Professional | | $41.69 | $46.77 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $60.26 / $89.13
| Professional | | $45.71 | $60.26 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $831.76 / $870.96
| Facility | | $562.34 | $831.76 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $63.10 / $97.72
| Professional | | $39.81 | $63.10 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $66.07 / $107.15
| Professional | | $45.71 | $66.07 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $48.98 / $134.90
| Professional | | $41.69 | $48.98 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $70.79 / $128.82
| Professional | | $43.65 | $70.79 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Professional | 25 | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $27.54 / $48.98
| Facility | | $26.92 | $27.54 | $48.98 |