- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $2,344.23 / $5,754.40
| Facility | | $323.59 | $2,344.23 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $891.25 / $2,238.72 / $6,456.54
| Facility | 25 | $891.25 | $2,238.72 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $181.97 / $478.63
| Professional | | $134.90 | $181.97 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $169.82 / $380.19 / $794.33
| Professional | 25 | $169.82 | $380.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $331.13 / $489.78
| Professional | | $173.78 | $331.13 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Professional | 25 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $354.81 / $436.52
| Professional | | $275.42 | $354.81 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $263.03 / $724.44
| Facility | | $165.96 | $263.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $870.96 / $2,238.72 / $6,456.54
| Facility | 25 | $870.96 | $2,238.72 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $169.82 / $380.19 / $660.69
| Professional | 25 | $169.82 | $380.19 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $331.13 / $346.74
| Facility | | $239.88 | $331.13 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $257.04 / $446.68
| Facility | | $169.82 | $257.04 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $2,754.23
| Facility | | $2,290.87 | $2,290.87 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $6,025.60 / $6,309.57
| Facility | | $4,466.84 | $6,025.60 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $338.84 / $562.34
| Professional | | $177.83 | $338.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | 25 | $89.13 | $89.13 | $89.13 |