- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $660.69 / $1,023.29
| Facility | | $131.83 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $436.52 / $724.44 / $1,071.52
| Facility | 25 | $436.52 | $724.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $229.09
| Professional | | $51.29 | $69.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $63.10 / $123.03 / $371.54
| Professional | 25 | $63.10 | $123.03 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $125.89 / $190.55
| Professional | | $61.66 | $125.89 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $316.23
| Professional | | $67.61 | $107.15 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $208.93
| Facility | | $63.10 | $107.15 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $208.93 / $234.42 / $288.40
| Facility | 25 | $208.93 | $234.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $117.49 / $501.19
| Professional | | $66.07 | $117.49 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $69.18 / $131.83 / $316.23
| Professional | 25 | $69.18 | $131.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $158.49
| Professional | | $100.00 | $131.83 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $125.89 / $190.55
| Professional | | $87.10 | $125.89 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $2,290.87
| Facility | | $851.14 | $851.14 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $128.82 / $165.96
| Professional | | $72.44 | $128.82 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,380.38 / $1,380.38
| Facility | | $1,202.26 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $100.00 / $169.82
| Professional | | $66.07 | $100.00 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $89.13 / $123.03
| Professional | 25 | $85.11 | $89.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $117.49
| Professional | | $97.72 | $117.49 | $117.49 |