- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $933.25 / $1,000.00
| Facility | | $194.98 | $933.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $302.00 / $575.44 / $977.24
| Facility | 25 | $302.00 | $575.44 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $66.07 / $131.83
| Professional | | $51.29 | $66.07 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $63.10 / $114.82 / $234.42
| Professional | 25 | $63.10 | $114.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $77.62 / $177.83
| Professional | | $66.07 | $77.62 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $177.83
| Professional | 25 | $67.61 | $95.50 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $1,737.80
| Facility | | $346.74 | $346.74 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $56.23 / $75.86
| Professional | | $51.29 | $56.23 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $93.33 / $177.83
| Facility | | $67.61 | $93.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $70.79 / $162.18
| Professional | | $64.57 | $70.79 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $75.86 / $107.15
| Professional | | $60.26 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $112.20
| Professional | | $74.13 | $93.33 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $74.13 / $89.13 / $144.54
| Professional | 25 | $74.13 | $89.13 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,122.02 / $3,162.28
| Facility | | $331.13 | $1,122.02 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $67.61 / $100.00
| Professional | | $54.95 | $67.61 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $199.53
| Professional | 25 | $75.86 | $89.13 | $199.53 |