- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $891.25 / $1,288.25
| Facility | | $263.03 | $891.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $512.86 / $954.99 / $1,548.82
| Facility | 25 | $512.86 | $954.99 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $70.79 / $416.87
| Professional | | $51.29 | $70.79 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $512.86
| Professional | 25 | $61.66 | $131.83 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $169.82
| Professional | | $66.07 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $117.49
| Professional | 25 | $66.07 | $83.18 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,202.26 / $1,202.26
| Facility | | $954.99 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $120.23 / $316.23
| Professional | | $61.66 | $120.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $79.43 / $102.33
| Facility | | $66.07 | $79.43 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $79.43 / $107.15
| Professional | | $66.07 | $79.43 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $147.91
| Professional | | $58.88 | $81.28 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,698.24 / $3,235.94
| Facility | | $707.95 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $69.18 / $158.49
| Professional | | $56.23 | $69.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $72.44 / $89.13 / $138.04
| Professional | 25 | $72.44 | $89.13 | $138.04 |