- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $912.01 / $1,548.82
| Facility | | $234.42 | $912.01 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $331.13 / $831.76 / $1,071.52
| Facility | 25 | $331.13 | $831.76 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $512.86
| Professional | | $53.70 | $70.79 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $64.57 / $331.13 / $524.81
| Professional | 25 | $64.57 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $208.93
| Professional | | $64.57 | $83.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $57.54 / $81.28 / $229.09
| Professional | 25 | $57.54 | $81.28 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $158.49
| Professional | | $67.61 | $95.50 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $1,348.96
| Facility | | $331.13 | $331.13 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $151.36
| Professional | | $61.66 | $83.18 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $72.44 / $190.55
| Professional | | $58.88 | $72.44 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,412.54 / $1,584.89
| Facility | | $1,023.29 | $1,412.54 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $125.89
| Professional | | $56.23 | $70.79 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $89.13 / $151.36
| Professional | 25 | $85.11 | $89.13 | $151.36 |