- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $676.08 / $912.01
| Facility | | $416.87 | $676.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $562.34 / $691.83 / $912.01
| Facility | 25 | $562.34 | $691.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $223.87
| Professional | | $52.48 | $69.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $58.88 / $134.90 / $338.84
| Professional | 25 | $58.88 | $134.90 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $812.83
| Facility | | $549.54 | $549.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $186.21 / $229.09
| Professional | | $109.65 | $186.21 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $147.91 / $186.21
| Professional | 25 | $89.13 | $147.91 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $501.19 / $602.56
| Facility | | $257.04 | $501.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $190.55 / $288.40
| Professional | | $102.33 | $190.55 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $478.63
| Facility | | $194.98 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $169.82 / $251.19
| Professional | | $114.82 | $169.82 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $562.34
| Facility | | $64.57 | $128.82 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $891.25
| Facility | 25 | $251.19 | $446.68 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $173.78 / $398.11
| Professional | | $102.33 | $173.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $128.82 / $186.21 / $371.54
| Professional | 25 | $128.82 | $186.21 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $954.99 / $977.24
| Facility | | $741.31 | $954.99 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $141.25 / $263.03
| Professional | | $72.44 | $141.25 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $151.36
| Professional | 25 | $89.13 | $89.13 | $151.36 |