- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $89.13
| Facility | | $63.10 | $79.43 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $199.53
| Professional | | $60.26 | $79.43 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $229.09
| Professional | 25 | $61.66 | $83.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $91.20
| Professional | | $54.95 | $69.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $74.13 / $93.33
| Professional | 25 | $61.66 | $74.13 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $257.04
| Facility | | $38.02 | $52.48 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $109.65
| Professional | | $51.29 | $69.18 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $186.21
| Professional | | $67.61 | $97.72 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $75.86 / $134.90
| Facility | | $60.26 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $524.81
| Professional | | $74.13 | $107.15 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $72.44 / $75.86 / $173.78
| Professional | 25 | $72.44 | $75.86 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $93.33
| Facility | | $57.54 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $151.36
| Professional | | $69.18 | $87.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $75.86 / $100.00 / $100.00
| Professional | 25 | $75.86 | $100.00 | $100.00 |