- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $1,778.28 / $2,344.23
| Facility | | $173.78 | $1,778.28 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $954.99 / $1,778.28 / $2,511.89
| Facility | 25 | $954.99 | $1,778.28 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $407.38
| Professional | | $91.20 | $120.23 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $95.50 / $173.78 / $575.44
| Professional | 25 | $95.50 | $173.78 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $562.34 / $870.96
| Facility | | $512.86 | $562.34 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $229.09 / $245.47
| Professional | | $177.83 | $229.09 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $263.03
| Professional | | $104.71 | $162.18 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $407.38
| Facility | | $120.23 | $173.78 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $398.11 / $1,000.00 / $7,079.46
| Facility | 25 | $398.11 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $371.54
| Professional | | $95.50 | $144.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $95.50 / $104.71 / $588.84
| Professional | 25 | $95.50 | $104.71 | $588.84 |
- 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
- $870.96 / $870.96 / $870.96
| Facility | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $234.42
| Professional | | $151.36 | $177.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $194.98 / $269.15
| Professional | | $109.65 | $194.98 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $234.42
| Professional | | $114.82 | $162.18 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $173.78
| Professional | 25 | $85.11 | $85.11 | $173.78 |