- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $588.84 / $812.83
| Facility | | $89.13 | $588.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $501.19 / $741.31 / $977.24
| Facility | 25 | $501.19 | $741.31 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $134.90
| Professional | | $33.11 | $61.66 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $41.69 / $89.13 / $165.96
| Professional | 25 | $41.69 | $89.13 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $79.43 / $117.49
| Professional | | $42.66 | $79.43 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $112.20
| Professional | | $64.57 | $85.11 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $69.18 / $181.97
| Facility | | $37.15 | $69.18 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $354.81 / $630.96 / $954.99
| Facility | 25 | $354.81 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $77.62 / $112.20
| Professional | | $44.67 | $77.62 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $83.18
| Facility | | $51.29 | $81.28 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $66.07 / $107.15
| Facility | | $38.02 | $66.07 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $112.20
| Professional | | $64.57 | $81.28 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $691.83
| Facility | | $575.44 | $575.44 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $114.82
| Professional | | $70.79 | $89.13 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,548.82 / $1,905.46
| Facility | | $1,023.29 | $1,548.82 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $85.11 / $134.90
| Professional | | $53.70 | $85.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 25 | $85.11 | $85.11 | $85.11 |