- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $6,025.60 / $8,128.31
| Facility | | $691.83 | $6,025.60 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $5,011.87 / $6,456.54 / $6,760.83
| Facility | 25 | $5,011.87 | $6,456.54 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $245.47 / $724.44
| Professional | | $173.78 | $245.47 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $154.88 / $398.11 / $831.76
| Professional | 25 | $154.88 | $398.11 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $758.58
| Professional | | $199.53 | $331.13 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $691.83
| Facility | | $213.80 | $338.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $4,786.30 / $5,623.41 / $7,079.46
| Facility | 25 | $4,786.30 | $5,623.41 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $645.65 / $1,348.96
| Professional | | $229.09 | $645.65 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $100.00 / $371.54 / $1,621.81
| Professional | 25 | $100.00 | $371.54 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $676.08 / $912.01
| Professional | | $512.86 | $676.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $331.13 / $575.44
| Facility | | $213.80 | $331.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $426.58 / $741.31
| Professional | | $199.53 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $389.05 / $912.01
| Professional | | $199.53 | $389.05 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Professional | 25 | $288.40 | $288.40 | $288.40 |