- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $223.87 / $380.19
| Facility | | $169.82 | $223.87 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $194.98 / $363.08 / $363.08
| Facility | 25 | $194.98 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $169.82 / $331.13
| Professional | | $131.83 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $446.68
| Professional | 25 | $134.90 | $208.93 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $131.83 / $154.88
| Professional | | $128.82 | $131.83 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $50.12 / $151.36 / $154.88
| Professional | 25 | $50.12 | $151.36 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $263.03 / $645.65
| Facility | | $218.78 | $263.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $186.21 / $263.03
| Professional | | $169.82 | $186.21 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $186.21
| Professional | | $141.25 | $141.25 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $263.03 / $407.38
| Professional | | $144.54 | $263.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $204.17 / $218.78
| Professional | | $199.53 | $204.17 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $169.82
| Professional | | $32.36 | $33.11 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $389.05
| Facility | | $162.18 | $190.55 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $204.17 / $316.23
| Professional | | $79.43 | $204.17 | $316.23 |