- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,380.38 / $4,365.16
| Facility | | $346.74 | $1,380.38 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $691.83 / $1,412.54 / $2,951.21
| Facility | 25 | $691.83 | $1,412.54 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $331.13
| Professional | | $89.13 | $114.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $95.50 / $331.13 / $741.31
| Professional | 25 | $95.50 | $331.13 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $288.40 / $426.58
| Professional | | $117.49 | $288.40 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $117.49 / $323.59 / $457.09
| Professional | 25 | $117.49 | $323.59 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,818.38 / $3,388.44
| Facility | | $1,737.80 | $2,818.38 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $144.54 / $239.88
| Professional | | $102.33 | $144.54 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,235.94 / $3,630.78
| Facility | | $2,951.21 | $3,235.94 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $138.04 / $223.87
| Professional | | $93.33 | $138.04 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $117.49 / $199.53
| Professional | | $1.26 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Professional | 25 | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.26 / $173.78
| Professional | | $1.26 | $1.26 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $117.49 / $245.47
| Professional | | $114.82 | $117.49 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $6,456.54
| Facility | | $5,128.61 | $5,128.61 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $131.83 / $223.87
| Professional | | $95.50 | $131.83 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $93.33 / $173.78
| Professional | 25 | $85.11 | $93.33 | $173.78 |