- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $1,000.00 / $1,905.46
| Facility | | $190.55 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $660.69 / $1,148.15 / $2,290.87
| Facility | 25 | $660.69 | $1,148.15 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $562.34
| Professional | | $125.89 | $177.83 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $165.96 / $389.05 / $870.96
| Professional | 25 | $165.96 | $389.05 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $363.08
| Professional | 25 | $144.54 | $181.97 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $891.25
| Facility | | $257.04 | $257.04 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $245.47 / $501.19
| Facility | | $165.96 | $245.47 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $707.95
| Professional | | $144.54 | $204.17 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $724.44 / $1,737.80
| Facility | | $154.88 | $724.44 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $660.69 / $1,122.02 / $2,570.40
| Facility | 25 | $660.69 | $1,122.02 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $169.82 / $380.19 / $977.24
| Professional | 25 | $169.82 | $380.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $549.54
| Professional | | $154.88 | $194.98 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $245.47
| Professional | 25 | $79.43 | $89.13 | $245.47 |