- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $2,818.38 / $3,019.95
| Facility | | $186.21 | $2,818.38 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $75.86 / $851.14 / $2,951.21
| Facility | 25 | $75.86 | $851.14 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $954.99
| Professional | | $128.82 | $177.83 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $134.90 / $407.38 / $1,122.02
| Professional | 25 | $134.90 | $407.38 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $147.91 / $204.17 / $457.09
| Professional | 25 | $147.91 | $204.17 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $2,137.96 / $2,691.53
| Facility | | $660.69 | $2,137.96 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $407.38 / $407.38
| Facility | | $169.82 | $407.38 | $407.38 |
- 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
- $147.91 / $199.53 / $446.68
| Professional | | $147.91 | $199.53 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,511.89 / $4,570.88
| Facility | | $794.33 | $2,511.89 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $177.83 / $263.03
| Professional | | $131.83 | $177.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $234.42 / $371.54
| Professional | 25 | $89.13 | $234.42 | $371.54 |