- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $933.25 / $2,951.21
| Facility | | $251.19 | $933.25 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $154.88 / $575.44 / $1,819.70
| Facility | 25 | $154.88 | $575.44 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $177.83
| Professional | | $50.12 | $67.61 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $125.89 / $245.47
| Professional | 25 | $66.07 | $125.89 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $74.13 / $186.21
| Professional | | $57.54 | $74.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $77.62 / $91.20
| Professional | 25 | $66.07 | $77.62 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $6,606.93
| Facility | | $4,073.80 | $4,073.80 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $245.47
| Professional | | $69.18 | $69.18 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,513.56 / $1,659.59
| Facility | | $1,230.27 | $1,513.56 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $190.55
| Professional | | $56.23 | $93.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $239.88
| Professional | | $81.28 | $117.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $6,918.31 / $10,471.29
| Facility | | $1,096.48 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $131.83
| Professional | | $50.12 | $72.44 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $79.43 / $234.42
| Professional | | $48.98 | $79.43 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $72.44 / $89.13 / $151.36
| Professional | 25 | $72.44 | $89.13 | $151.36 |