- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $199.53 / $309.03
| Facility | | $61.66 | $199.53 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $208.93
| Professional | | $56.23 | $100.00 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | 25 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $131.83 / $269.15
| Professional | | $107.15 | $131.83 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $426.58 / $870.96
| Facility | | $257.04 | $426.58 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $288.40
| Professional | | $123.03 | $177.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $181.97 / $316.23
| Professional | | $75.86 | $181.97 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $85.11 / $194.98
| Facility | | $46.77 | $85.11 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $177.83
| Professional | | $46.77 | $83.18 | $177.83 |
- 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
- $104.71 / $223.87 / $269.15
| Facility | | $104.71 | $223.87 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $323.59
| Professional | | $117.49 | $173.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $870.96
| Facility | | $302.00 | $446.68 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $281.84
| Professional | | $123.03 | $177.83 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $660.69 / $1,202.26
| Facility | | $501.19 | $660.69 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $131.83 / $281.84
| Professional | | $72.44 | $131.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $208.93
| Professional | | $85.11 | $147.91 | $208.93 |