- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $794.33 / $1,000.00
| Facility | | $302.00 | $794.33 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $398.11 / $776.25 / $1,023.29
| Facility | 25 | $398.11 | $776.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $72.44 / $512.86
| Professional | | $52.48 | $72.44 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $154.88 / $512.86
| Professional | 25 | $61.66 | $154.88 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $123.03
| Facility | | $69.18 | $81.28 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $79.43 / $162.18
| Professional | | $67.61 | $79.43 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $331.13
| Professional | | $60.26 | $91.20 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | 25 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $93.33 / $144.54
| Professional | | $89.13 | $93.33 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $83.18 / $93.33 / $144.54
| Professional | 25 | $83.18 | $93.33 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $72.44 / $141.25
| Professional | | $48.98 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $97.72
| Professional | 25 | $85.11 | $85.11 | $97.72 |