- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,445.44 / $6,456.54
| Facility | | $489.78 | $1,445.44 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $812.83 / $2,041.74 / $7,244.36
| Facility | 25 | $812.83 | $2,041.74 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $549.54
| Professional | | $120.23 | $177.83 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $162.18 / $346.74 / $724.44
| Professional | 25 | $162.18 | $346.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $162.18 / $169.82 / $302.00
| Professional | 25 | $162.18 | $169.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $407.38
| Professional | | $141.25 | $177.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $269.15 / $645.65
| Professional | | $151.36 | $269.15 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $416.87
| Facility | | $34.67 | $41.69 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $173.78 / $208.93 / $213.80
| Professional | 25 | $173.78 | $208.93 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $190.55 / $234.42 / $933.25
| Professional | 25 | $190.55 | $234.42 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,801.89 / $4,466.84
| Facility | | $2,187.76 | $3,801.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $295.12 / $575.44
| Professional | | $165.96 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $64.57 / $89.13 / $371.54
| Professional | 25 | $64.57 | $89.13 | $371.54 |