- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $794.33 / $933.25
| Facility | | $776.25 | $794.33 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $616.60 / $891.25 / $1,778.28
| Facility | 25 | $616.60 | $891.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $114.82 / $204.17
| Professional | | $79.43 | $114.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $25.70 / $229.09 / $724.44
| Professional | 25 | $25.70 | $229.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $114.82 / $208.93
| Professional | | $91.20 | $114.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $114.82 / $177.83 / $208.93
| Professional | 25 | $114.82 | $177.83 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,230.27 / $1,949.84
| Facility | | $977.24 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $120.23 / $204.17
| Professional | | $107.15 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $234.42
| Professional | | $104.71 | $162.18 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $177.83
| Professional | | $32.36 | $33.11 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $263.03
| Facility | | $109.65 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $177.83 / $302.00
| Professional | | $114.82 | $177.83 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $2,951.21
| Facility | | $1,819.70 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $275.42
| Professional | | $109.65 | $162.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $173.78
| Professional | 25 | $79.43 | $89.13 | $173.78 |