- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $954.99 / $1,348.96
| Facility | | $354.81 | $954.99 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $676.08 / $954.99 / $1,318.26
| Facility | 25 | $676.08 | $954.99 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $131.83 / $724.44
| Professional | | $89.13 | $131.83 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $97.72 / $263.03 / $794.33
| Professional | 25 | $97.72 | $263.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $131.83 / $208.93
| Professional | | $109.65 | $131.83 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $186.21
| Professional | 25 | $100.00 | $128.82 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $512.86 / $630.96
| Facility | | $239.88 | $512.86 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $173.78
| Professional | | $138.04 | $162.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $257.04
| Professional | | $104.71 | $165.96 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $275.42 / $954.99
| Professional | | $120.23 | $275.42 | $954.99 |
- 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
- $1,047.13 / $1,548.82 / $3,090.30
| Facility | | $1,047.13 | $1,548.82 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $186.21 / $416.87
| Professional | | $104.71 | $186.21 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $199.53
| Professional | 25 | $79.43 | $89.13 | $199.53 |