- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $831.76 / $1,737.80
| Facility | | $331.13 | $831.76 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $363.08 / $977.24 / $2,041.74
| Facility | 25 | $363.08 | $977.24 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $204.17
| Professional | | $52.48 | $70.79 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $141.25 / $346.74
| Professional | 25 | $66.07 | $141.25 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $251.19
| Professional | | $72.44 | $112.20 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $102.33 / $831.76
| Facility | | $70.79 | $102.33 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $239.88 / $977.24 / $2,041.74
| Facility | 25 | $239.88 | $977.24 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $147.91 / $323.59
| Professional | | $60.26 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $199.53 / $741.31
| Professional | 25 | $66.07 | $199.53 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $426.58 / $426.58
| Professional | | $158.49 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $177.83
| Facility | | $69.18 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $239.88
| Professional | | $72.44 | $112.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $173.78 / $323.59
| Professional | | $61.66 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Professional | 25 | $91.20 | $91.20 | $91.20 |