- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $549.54 / $1,995.26
| Facility | | $467.74 | $549.54 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $398.11 / $741.31 / $1,819.70
| Facility | 25 | $398.11 | $741.31 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $128.82 / $707.95
| Professional | | $93.33 | $128.82 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $100.00 / $275.42 / $812.83
| Professional | 25 | $100.00 | $275.42 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $302.00
| Professional | | $112.20 | $169.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $112.20 / $134.90 / $302.00
| Professional | 25 | $112.20 | $134.90 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,479.11 / $1,862.09
| Facility | | $660.69 | $1,479.11 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $173.78
| Professional | | $123.03 | $154.88 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $295.12 / $295.12
| Facility | | $117.49 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $4,570.88
| Facility | | $870.96 | $870.96 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $131.83 / $309.03
| Professional | | $102.33 | $131.83 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,819.70 / $2,951.21
| Facility | | $602.56 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $117.49 / $181.97
| Professional | | $91.20 | $117.49 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $173.78
| Professional | 25 | $79.43 | $89.13 | $173.78 |