- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $870.96 / $1,148.15
| Facility | | $251.19 | $870.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $346.74 / $851.14 / $1,174.90
| Facility | 25 | $346.74 | $851.14 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $512.86
| Professional | | $52.48 | $70.79 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $64.57 / $229.09 / $524.81
| Professional | 25 | $64.57 | $229.09 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $83.18 / $104.71
| Professional | | $67.61 | $83.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $104.71
| Professional | 25 | $67.61 | $85.11 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $426.58 / $512.86
| Facility | | $295.12 | $426.58 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $81.28 / $89.13
| Professional | | $75.86 | $81.28 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $77.62 / $120.23
| Professional | | $60.26 | $77.62 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Professional | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $81.28 / $151.36
| Facility | | $63.10 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,905.46 / $2,398.83
| Facility | | $1,778.28 | $1,905.46 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $64.57 / $112.20
| Professional | | $53.70 | $64.57 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $199.53
| Professional | 25 | $89.13 | $89.13 | $199.53 |