- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $588.84 / $912.01
| Facility | | $75.86 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $537.03 / $891.25 / $1,202.26
| Facility | 25 | $537.03 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $66.07 / $165.96
| Professional | | $51.29 | $66.07 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $128.82 / $208.93
| Professional | 25 | $66.07 | $128.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $194.98
| Professional | | $64.57 | $79.43 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $75.86 / $95.50
| Professional | 25 | $66.07 | $75.86 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $131.83
| Professional | | $75.86 | $91.20 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,949.84
| Facility | | $1,584.89 | $1,584.89 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $177.83
| Professional | | $67.61 | $104.71 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $181.97
| Professional | | $79.43 | $112.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $79.43 / $208.93
| Professional | | $67.61 | $79.43 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $208.93
| Professional | | $75.86 | $112.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $77.62 / $89.13 / $151.36
| Professional | 25 | $77.62 | $89.13 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $44.67 / $83.18
| Facility | | $43.65 | $44.67 | $83.18 |