- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $416.87 / $588.84
| Facility | | $38.90 | $416.87 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $398.11 / $524.81 / $812.83
| Facility | 25 | $398.11 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $93.33
| Professional | | $30.20 | $48.98 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $45.71 / $89.13 / $309.03
| Professional | 25 | $45.71 | $89.13 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $102.33
| Professional | | $39.81 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $48.98 / $81.28
| Professional | | $41.69 | $48.98 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $741.31 / $1,202.26
| Facility | | $588.84 | $741.31 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $97.72
| Professional | | $33.88 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $141.25
| Professional | | $38.02 | $47.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $51.29 / $77.62
| Professional | | $41.69 | $51.29 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $56.23 / $97.72
| Facility | | $38.90 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $81.28
| Facility | | $37.15 | $47.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $81.28
| Professional | | $37.15 | $47.86 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $954.99 / $2,089.30
| Facility | | $794.33 | $954.99 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $93.33
| Professional | | $30.90 | $45.71 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $87.10
| Professional | 25 | $67.61 | $85.11 | $87.10 |