- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,445.44 / $3,162.28
| Facility | | $363.08 | $1,445.44 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $1,348.96 / $1,819.70 / $3,981.07
| Facility | 25 | $1,348.96 | $1,819.70 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $616.60
| Professional | | $128.82 | $177.83 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $151.36 / $354.81 / $758.58
| Professional | 25 | $151.36 | $354.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $1,819.70
| Facility | | $562.34 | $562.34 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $218.78 / $363.08 / $467.74
| Professional | 25 | $218.78 | $363.08 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,230.27 / $1,479.11
| Facility | | $630.96 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $457.09 / $707.95
| Professional | | $251.19 | $457.09 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $691.83 / $1,174.90
| Facility | | $478.63 | $691.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $275.42 / $1,412.54
| Facility | | $158.49 | $275.42 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $1,258.93 / $1,513.56 / $2,344.23
| Facility | 25 | $1,258.93 | $1,513.56 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $371.54 / $537.03 / $912.01
| Professional | 25 | $371.54 | $537.03 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $2,041.74
| Facility | | $1,862.09 | $1,862.09 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $389.05 / $645.65
| Professional | | $173.78 | $389.05 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $371.54
| Professional | 25 | $79.43 | $89.13 | $371.54 |