- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $2,187.76 / $2,818.38
| Facility | | $426.58 | $2,187.76 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $812.83 / $2,630.27 / $5,754.40
| Facility | 25 | $812.83 | $2,630.27 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $120.23 / $316.23
| Professional | | $89.13 | $120.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $97.72 / $208.93 / $512.86
| Professional | 25 | $97.72 | $208.93 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $141.25 / $436.52
| Professional | | $104.71 | $141.25 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $104.71 / $131.83 / $398.11
| Professional | 25 | $104.71 | $131.83 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $125.89 / $138.04
| Professional | | $102.33 | $125.89 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,630.27 / $3,388.44
| Facility | | $1,318.26 | $2,630.27 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $154.88 / $331.13
| Professional | | $102.33 | $154.88 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $4,073.80
| Facility | | $1,122.02 | $1,122.02 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $104.71 / $147.91
| Professional | | $63.10 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $107.15 / $213.80
| Professional | | $32.36 | $107.15 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $251.19
| Professional | | $87.10 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $151.36
| Professional | 25 | $79.43 | $85.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $125.89
| Professional | | $91.20 | $91.20 | $125.89 |