- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $977.24 / $2,238.72
| Facility | | $134.90 | $977.24 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $478.63 / $776.25 / $1,949.84
| Facility | 25 | $478.63 | $776.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $117.49 / $257.04
| Professional | | $85.11 | $117.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $104.71 / $208.93 / $354.81
| Professional | 25 | $104.71 | $208.93 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $138.04 / $302.00
| Professional | | $112.20 | $138.04 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $316.23
| Professional | 25 | $100.00 | $162.18 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $2,137.96
| Facility | | $416.87 | $416.87 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $112.20 / $147.91
| Professional | | $102.33 | $112.20 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $158.49 / $363.08
| Facility | | $114.82 | $158.49 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $120.23 / $281.84
| Professional | | $109.65 | $120.23 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $199.53
| Professional | | $104.71 | $134.90 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $169.82 / $478.63
| Professional | | $125.89 | $169.82 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $128.82 / $158.49 / $478.63
| Professional | 25 | $128.82 | $158.49 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,737.80 / $3,715.35
| Facility | | $512.86 | $1,737.80 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $181.97
| Professional | | $97.72 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $338.84
| Professional | 25 | $89.13 | $128.82 | $338.84 |