- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $38.02
| Facility | | $25.70 | $25.70 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $37.15 / $83.18
| Professional | | $23.99 | $37.15 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $30.90 / $72.44 / $173.78
| Professional | 25 | $30.90 | $72.44 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Professional | 52 | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $134.90 / $275.42
| Facility | | $48.98 | $134.90 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $79.43 / $141.25
| Professional | | $42.66 | $79.43 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $125.89 / $346.74
| Facility | | $83.18 | $125.89 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $54.95
| Professional | | $29.51 | $37.15 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $269.15
| Facility | | $91.20 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $42.66
| Professional | | $29.51 | $38.02 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $42.66 / $81.28
| Facility | | $26.30 | $42.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $81.28 / $173.78
| Professional | | $38.02 | $81.28 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $151.36
| Professional | 25 | $144.54 | $144.54 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 52 | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $58.88 / $102.33
| Professional | | $30.90 | $58.88 | $102.33 |