- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $489.78 / $977.24
| Facility | | $37.15 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $138.04 / $467.74 / $933.25
| Facility | 25 | $138.04 | $467.74 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $57.54 / $331.13
| Professional | | $33.11 | $57.54 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $64.57 / $177.83 / $354.81
| Professional | 25 | $64.57 | $177.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $123.03
| Professional | | $38.90 | $47.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $95.50
| Professional | | $39.81 | $57.54 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $1,047.13
| Facility | | $154.88 | $154.88 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $95.50
| Professional | | $36.31 | $50.12 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $151.36
| Professional | | $33.88 | $47.86 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $794.33 / $1,230.27
| Facility | | $562.34 | $794.33 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $79.43
| Professional | | $33.11 | $44.67 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $44.67 / $85.11 / $87.10
| Professional | 25 | $44.67 | $85.11 | $87.10 |