- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $478.63 / $1,445.44
| Facility | | $57.54 | $478.63 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $123.03 / $371.54 / $977.24
| Facility | 25 | $123.03 | $371.54 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $52.48 / $125.89
| Professional | | $30.20 | $52.48 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $141.25
| Professional | 25 | $48.98 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $45.71 / $165.96
| Professional | | $38.02 | $45.71 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $97.72 / $186.21
| Professional | | $41.69 | $97.72 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $398.11 / $436.52
| Facility | | $323.59 | $398.11 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $125.89
| Professional | | $32.36 | $57.54 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $63.10 / $138.04
| Professional | | $46.77 | $63.10 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $512.86 / $645.65
| Facility | | $302.00 | $512.86 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $85.11
| Professional | | $33.88 | $46.77 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $50.12 / $138.04
| Professional | | $28.18 | $50.12 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $85.11
| Professional | 25 | $67.61 | $67.61 | $85.11 |