- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $724.44 / $1,258.93
| Facility | | $144.54 | $724.44 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $380.19 / $831.76 / $1,584.89
| Facility | 25 | $380.19 | $831.76 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $158.49
| Professional | | $51.29 | $69.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $58.88 / $109.65 / $204.17
| Professional | 25 | $58.88 | $109.65 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $70.79 / $138.04
| Professional | | $63.10 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $239.88
| Professional | 25 | $79.43 | $89.13 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,659.59
| Facility | | $1,548.82 | $1,548.82 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $229.09
| Professional | | $63.10 | $74.13 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $138.04
| Professional | | $79.43 | $120.23 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $177.83
| Professional | | $60.26 | $81.28 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $204.17
| Professional | | $69.18 | $125.89 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $89.13 / $138.04
| Professional | | $63.10 | $89.13 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $776.25 / $812.83
| Facility | | $741.31 | $776.25 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $691.83 / $758.58 / $1,348.96
| Facility | 25 | $691.83 | $758.58 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $131.83
| Professional | | $75.86 | $91.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $128.82
| Professional | 25 | $74.13 | $93.33 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,548.82 / $1,659.59
| Facility | | $851.14 | $1,548.82 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $79.43 / $229.09
| Professional | | $74.13 | $79.43 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $870.96
| Facility | | $53.70 | $70.79 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $741.31 / $831.76 / $831.76
| Facility | 25 | $741.31 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $134.90
| Professional | | $51.29 | $69.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $165.96
| Professional | | $61.66 | $72.44 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $158.49
| Professional | | $69.18 | $109.65 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $63.10 / $112.20
| Professional | | $38.02 | $63.10 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,479.11 / $2,454.71
| Facility | | $630.96 | $1,479.11 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $77.62 / $154.88
| Professional | | $56.23 | $77.62 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $72.44 / $85.11 / $89.13
| Professional | 25 | $72.44 | $85.11 | $89.13 |