- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $870.96 / $1,698.24
| Facility | | $194.98 | $870.96 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $288.40 / $831.76 / $1,737.80
| Facility | 25 | $288.40 | $831.76 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $223.87
| Professional | | $52.48 | $75.86 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $141.25 / $309.03
| Professional | 25 | $67.61 | $141.25 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $134.90 / $199.53
| Professional | | $70.79 | $134.90 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $144.54 / $194.98
| Professional | | $112.20 | $144.54 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $102.33 / $323.59
| Facility | | $66.07 | $102.33 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $288.40 / $851.14 / $1,513.56
| Facility | 25 | $288.40 | $851.14 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $123.03 / $190.55
| Professional | | $66.07 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $147.91 / $309.03
| Professional | 25 | $66.07 | $147.91 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $123.03 / $138.04
| Facility | | $74.13 | $123.03 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $162.18
| Facility | | $67.61 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $134.90 / $190.55
| Professional | | $79.43 | $134.90 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,230.27
| Facility | | $1,023.29 | $1,023.29 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $194.98
| Professional | | $114.82 | $151.36 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,511.89 / $3,162.28
| Facility | | $2,290.87 | $2,511.89 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $229.09
| Professional | | $79.43 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $89.13 / $91.20
| Professional | 25 | $85.11 | $89.13 | $91.20 |