- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $575.44 / $870.96
| Facility | | $77.62 | $575.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $295.12 / $645.65 / $954.99
| Facility | 25 | $295.12 | $645.65 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $218.78
| Professional | | $52.48 | $70.79 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $147.91 / $398.11
| Professional | 25 | $66.07 | $147.91 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $93.33 / $147.91
| Professional | | $67.61 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $72.44 / $83.18 / $123.03
| Professional | 25 | $72.44 | $83.18 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $104.71 / $363.08
| Facility | | $89.13 | $104.71 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $112.20 / $123.03
| Professional | | $102.33 | $112.20 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $151.36
| Facility | | $67.61 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $162.18
| Professional | | $66.07 | $83.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $275.42
| Professional | | $54.95 | $75.86 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $436.52 / $831.76
| Facility | | $64.57 | $436.52 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $295.12 / $645.65 / $954.99
| Facility | 25 | $295.12 | $645.65 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $173.78
| Professional | | $53.70 | $72.44 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $154.88 / $416.87
| Professional | 25 | $66.07 | $154.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $138.04
| Professional | | $53.70 | $72.44 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $229.09
| Professional | | $61.66 | $79.43 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $89.13 / $109.65
| Professional | 25 | $85.11 | $89.13 | $109.65 |