- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $83.18 / $109.65
| Facility | | $75.86 | $83.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $77.62 / $186.21
| Professional | | $60.26 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $186.21
| Professional | 25 | $58.88 | $83.18 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $87.10
| Professional | | $61.66 | $72.44 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $87.10
| Professional | 25 | $64.57 | $72.44 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $54.95 / $70.79
| Facility | | $40.74 | $54.95 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $89.13
| Professional | | $61.66 | $72.44 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $79.43
| Facility | | $64.57 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $177.83
| Professional | | $64.57 | $85.11 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $123.03
| Facility | | $114.82 | $114.82 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $125.89
| Professional | | $63.10 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $100.00
| Professional | 25 | $87.10 | $87.10 | $100.00 |