- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $933.25 / $3,801.89
| Facility | | $186.21 | $933.25 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $208.93 / $812.83 / $4,265.80
| Facility | 25 | $208.93 | $812.83 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $616.60
| Professional | | $173.78 | $251.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $190.55 / $354.81 / $812.83
| Professional | 25 | $190.55 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $218.78 / $457.09
| Professional | | $186.21 | $218.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $169.82 / $204.17 / $245.47
| Professional | 25 | $169.82 | $204.17 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $660.69
| Professional | | $213.80 | $213.80 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,659.59 / $2,290.87
| Facility | | $331.13 | $1,659.59 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $309.03 / $588.84
| Professional | | $204.17 | $309.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $436.52 / $676.08
| Professional | | $323.59 | $436.52 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,570.40 / $4,265.80
| Facility | | $1,659.59 | $2,570.40 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $549.54
| Professional | | $229.09 | $288.40 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $275.42 / $588.84
| Professional | | $162.18 | $275.42 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $64.57 / $288.40 / $467.74
| Professional | 25 | $64.57 | $288.40 | $467.74 |