- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $2,089.30 / $4,365.16
| Facility | | $181.97 | $2,089.30 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $707.95 / $4,365.16 / $8,511.38
| Facility | 25 | $707.95 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $630.96
| Professional | | $177.83 | $269.15 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $891.25
| Professional | 25 | $190.55 | $363.08 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $245.47 / $501.19
| Professional | | $186.21 | $245.47 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $194.98 / $263.03 / $660.69
| Professional | 25 | $194.98 | $263.03 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $208.93 / $218.78
| Facility | | $199.53 | $208.93 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $257.04 / $323.59
| Professional | | $213.80 | $257.04 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $812.83 / $5,495.41
| Facility | | $331.13 | $812.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $562.34
| Professional | | $204.17 | $302.00 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,630.27 / $4,073.80
| Facility | | $1,122.02 | $2,630.27 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $371.54
| Professional | | $125.89 | $239.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $213.80 / $436.52
| Professional | | $32.36 | $213.80 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $575.44
| Facility | | $239.88 | $239.88 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $257.04 / $467.74
| Professional | | $177.83 | $257.04 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $288.40 / $398.11
| Professional | 25 | $79.43 | $288.40 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $208.93 / $309.03
| Professional | | $162.18 | $208.93 | $309.03 |