- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $524.81 / $741.31
| Facility | | $125.89 | $524.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $389.05 / $501.19 / $1,174.90
| Facility | 25 | $389.05 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $57.54 / $323.59
| Professional | | $33.11 | $57.54 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $54.95 / $144.54 / $354.81
| Professional | 25 | $54.95 | $144.54 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $70.79
| Professional | | $38.90 | $48.98 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $275.42
| Facility | | $144.54 | $208.93 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $70.79
| Professional | | $33.88 | $45.71 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $93.33
| Facility | | $36.31 | $54.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $912.01 / $1,584.89
| Facility | | $707.95 | $912.01 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $41.69 / $72.44
| Professional | | $33.11 | $41.69 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | 25 | $87.10 | $87.10 | $87.10 |