- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $407.38 / $954.99
| Facility | | $138.04 | $407.38 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $354.81 / $602.56 / $933.25
| Facility | 25 | $354.81 | $602.56 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $100.00
| Professional | | $32.36 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $144.54
| Professional | 25 | $50.12 | $75.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $162.18
| Professional | | $60.26 | $60.26 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,659.59
| Facility | | $1,548.82 | $1,548.82 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $239.88
| Professional | | $38.02 | $47.86 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $478.63
| Facility | | $467.74 | $467.74 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $57.54
| Professional | | $37.15 | $43.65 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $91.20
| Professional | | $34.67 | $50.12 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $74.13 / $120.23
| Professional | | $40.74 | $74.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $83.18
| Professional | | $34.67 | $52.48 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $446.68 / $758.58
| Facility | | $389.05 | $446.68 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $398.11 / $436.52 / $794.33
| Facility | 25 | $398.11 | $436.52 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $69.18
| Professional | | $41.69 | $54.95 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,548.82 / $1,659.59
| Facility | | $851.14 | $1,548.82 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $245.47
| Professional | | $44.67 | $54.95 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $407.38
| Facility | | $35.48 | $58.88 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $478.63
| Facility | 25 | $457.09 | $457.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $53.70 / $95.50
| Professional | | $31.62 | $53.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $43.65 / $109.65
| Professional | | $35.48 | $43.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $1,096.48
| Facility | | $158.49 | $158.49 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $70.79 / $91.20
| Professional | | $33.11 | $70.79 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $46.77 / $190.55
| Professional | | $26.30 | $46.77 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $776.25 / $912.01
| Facility | | $457.09 | $776.25 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $95.50
| Professional | | $35.48 | $48.98 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $87.10
| Professional | 25 | $67.61 | $85.11 | $87.10 |