- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $676.08 / $1,348.96
| Facility | | $72.44 | $676.08 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $269.15 / $501.19 / $1,659.59
| Facility | 25 | $269.15 | $501.19 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $457.09
| Professional | | $52.48 | $70.79 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $173.78 / $524.81
| Professional | 25 | $61.66 | $173.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $177.83
| Professional | | $66.07 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $181.97
| Professional | 25 | $66.07 | $83.18 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $954.99 / $1,174.90
| Facility | | $380.19 | $954.99 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $100.00
| Professional | | $64.57 | $85.11 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $147.91 / $147.91
| Facility | | $69.18 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $794.33
| Facility | | $549.54 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $181.97
| Professional | | $56.23 | $79.43 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,096.48 / $1,659.59
| Facility | | $501.19 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $66.07 / $102.33
| Professional | | $50.12 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $151.36
| Professional | 25 | $89.13 | $89.13 | $151.36 |