- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $457.09
| Facility | | $245.47 | $389.05 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $389.05
| Facility | 25 | $229.09 | $288.40 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $114.82
| Professional | | $30.90 | $52.48 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $57.54 / $95.50 / $190.55
| Professional | 25 | $57.54 | $95.50 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $66.07
| Professional | | $35.48 | $54.95 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $74.13 / $91.20
| Professional | | $39.81 | $74.13 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $60.26 / $93.33
| Facility | | $39.81 | $60.26 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $70.79 / $501.19
| Professional | | $42.66 | $70.79 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $83.18
| Professional | | $60.26 | $79.43 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $91.20
| Professional | | $66.07 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $69.18 / $81.28
| Professional | | $50.12 | $69.18 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $70.79 / $109.65
| Professional | | $44.67 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $85.11
| Professional | 25 | $67.61 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $70.79 / $97.72
| Professional | | $58.88 | $70.79 | $97.72 |