- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $831.76 / $831.76
| Facility | | $72.44 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $64.57 / $676.08 / $1,949.84
| Facility | 25 | $64.57 | $676.08 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $478.63
| Professional | | $51.29 | $69.18 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $134.90 / $512.86
| Professional | 25 | $61.66 | $134.90 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $162.18
| Professional | | $66.07 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $75.86 / $181.97
| Professional | 25 | $66.07 | $75.86 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $77.62
| Professional | | $69.18 | $69.18 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $70.79 / $117.49
| Professional | | $58.88 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $954.99 / $2,454.71
| Facility | | $831.76 | $954.99 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $66.07 / $89.13
| Professional | | $53.70 | $66.07 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $91.20
| Professional | 25 | $89.13 | $89.13 | $91.20 |