- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $630.96 / $954.99
| Facility | | $81.28 | $630.96 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $776.25 / $954.99 / $1,000.00
| Facility | 25 | $776.25 | $954.99 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $223.87
| Professional | | $53.70 | $70.79 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $60.26 / $120.23 / $426.58
| Professional | 25 | $60.26 | $120.23 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $338.84 / $512.86
| Facility | | $309.03 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $144.54
| Professional | | $104.71 | $134.90 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $93.33 / $141.25
| Professional | | $61.66 | $93.33 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $93.33 / $194.98
| Facility | | $66.07 | $93.33 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $489.78 / $891.25 / $1,000.00
| Facility | 25 | $489.78 | $891.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $218.78
| Professional | | $58.88 | $75.86 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $58.88 / $120.23 / $436.52
| Professional | 25 | $58.88 | $120.23 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $112.20
| Professional | | $32.36 | $33.11 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $104.71 / $138.04
| Professional | | $89.13 | $104.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $114.82 / $158.49
| Professional | | $64.57 | $114.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $89.13 / $141.25
| Professional | | $64.57 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $89.13
| Professional | 25 | $85.11 | $85.11 | $89.13 |