- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $1,995.26 / $2,818.38
| Facility | | $275.42 | $1,995.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $354.81 / $1,513.56 / $3,235.94
| Facility | 25 | $354.81 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $165.96
| Professional | | $51.29 | $69.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $125.89 / $331.13
| Professional | 25 | $61.66 | $125.89 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $87.10 / $223.87
| Professional | | $61.66 | $87.10 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $58.88 / $72.44 / $234.42
| Professional | 25 | $58.88 | $72.44 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $79.43
| Professional | | $60.26 | $70.79 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,348.96 / $1,584.89
| Facility | | $616.60 | $1,348.96 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $186.21
| Professional | | $58.88 | $85.11 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $1,698.24
| Facility | | $575.44 | $575.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $63.10 / $87.10
| Professional | | $33.11 | $63.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $63.10 / $128.82
| Professional | | $32.36 | $63.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $154.88
| Professional | | $48.98 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $91.20
| Professional | 25 | $70.79 | $89.13 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $75.86
| Professional | | $53.70 | $53.70 | $75.86 |