- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $2,290.87 / $3,548.13
| Facility | | $165.96 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $524.81 / $2,290.87 / $3,715.35
| Facility | 25 | $524.81 | $2,290.87 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $407.38
| Professional | | $123.03 | $169.82 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $151.36 / $316.23 / $741.31
| Professional | 25 | $151.36 | $316.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $239.88 / $426.58
| Professional | | $165.96 | $239.88 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,677.35 / $4,786.30
| Facility | | $3,630.78 | $4,677.35 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $389.05
| Professional | | $154.88 | $213.80 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $602.56
| Professional | | $162.18 | $204.17 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $323.59
| Professional | | $154.88 | $194.98 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $223.87 / $407.38
| Facility | | $165.96 | $223.87 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $199.53 / $338.84
| Facility | | $173.78 | $199.53 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,162.28 / $6,760.83
| Facility | | $2,511.89 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $190.55 / $363.08
| Professional | | $131.83 | $190.55 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $371.54
| Professional | 25 | $79.43 | $89.13 | $371.54 |