- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $933.25 / $3,162.28
| Facility | | $416.87 | $933.25 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $501.19 / $954.99 / $2,951.21
| Facility | 25 | $501.19 | $954.99 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $776.25
| Professional | | $93.33 | $131.83 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $100.00 / $537.03 / $870.96
| Professional | 25 | $100.00 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $147.91 / $416.87
| Professional | | $112.20 | $147.91 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $257.04
| Professional | 25 | $97.72 | $138.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $263.03
| Professional | | $114.82 | $162.18 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $3,630.78
| Facility | | $1,819.70 | $1,819.70 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $144.54 / $269.15
| Professional | | $112.20 | $144.54 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Professional | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $288.40
| Professional | | $97.72 | $134.90 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,630.27 / $3,311.31
| Facility | | $1,621.81 | $2,630.27 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $223.87
| Professional | | $97.72 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $151.36
| Professional | 25 | $79.43 | $89.13 | $151.36 |