- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $977.24 / $2,344.23
| Facility | | $239.88 | $977.24 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $524.81 / $954.99 / $3,019.95
| Facility | 25 | $524.81 | $954.99 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $371.54
| Professional | | $91.20 | $131.83 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $100.00 / $251.19 / $467.74
| Professional | 25 | $100.00 | $251.19 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $229.09 / $338.84
| Professional | | $120.23 | $229.09 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $263.03
| Professional | | $213.80 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $245.47 / $331.13
| Professional | | $190.55 | $245.47 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $177.83 / $380.19
| Facility | | $114.82 | $177.83 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $489.78 / $954.99 / $2,884.03
| Facility | 25 | $489.78 | $954.99 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $213.80 / $323.59
| Professional | | $114.82 | $213.80 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $100.00 / $251.19 / $457.09
| Professional | 25 | $100.00 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $223.87 / $234.42
| Facility | | $138.04 | $223.87 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $302.00
| Facility | | $117.49 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $234.42 / $323.59
| Professional | | $79.43 | $234.42 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,905.46
| Facility | | $1,584.89 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $257.04 / $331.13
| Professional | | $204.17 | $257.04 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,890.45 / $4,570.88
| Facility | | $3,467.37 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $234.42 / $380.19
| Professional | | $131.83 | $234.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $173.78
| Professional | 25 | $79.43 | $89.13 | $173.78 |